Successful Treatment of Bacteremia and Ventilator-Associated Pneumonia Caused by KPC/OXA-48-like Klebsiella pneumoniae Co-Producer with a Continuous Infusion of High-Dose Meropenem Plus Fosfomycin Guided by Real-Time Therapeutic Drug Monitoring

Pier Giorgio Cojutti; Giacomo Fornaro; Milo Gatti; Matteo Rinaldi; Paolo Gaibani; Maddalena Giannella; Federico Pea; Pierluigi Viale

doi:10.3390/idr14010010

Successful Treatment of Bacteremia and Ventilator-Associated Pneumonia Caused by KPC/OXA-48-like Klebsiella pneumoniae Co-Producer with a Continuous Infusion of High-Dose Meropenem Plus Fosfomycin Guided by Real-Time Therapeutic Drug Monitoring

Infect Dis Rep. 2022 Jan 21;14(1):88-92. doi: 10.3390/idr14010010.

Authors

Pier Giorgio Cojutti¹, Giacomo Fornaro^{2

3}, Milo Gatti^{1

2}, Matteo Rinaldi^{2

3}, Paolo Gaibani⁴, Maddalena Giannella^{2

3}, Federico Pea^{1

2}, Pierluigi Viale^{2

3}

Affiliations

¹ SSD Clinical Pharmacology, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.
² Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
³ Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.
⁴ Division of Microbiology, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.

Abstract

Bacteremia and ventilator-associated pneumonia due to a pan-resistant Klebsiella pneumoniae strain co-producing KPC and OXA-48 carbapenemases was successfully treated in a COVID-19 critically ill patient with a combination therapy of a high-dose continuous infusion of meropenem (up to 3 g every 6 h, daily) plus fosfomycin (up to 24 g/daily) that was guided by real-time therapeutic drug monitoring. Clinical pharmacological advice was helpful in maximizing, over time, the pharmacodynamic target attainment of both antibiotics.

Keywords: continuous infusion of meropenem; critically ill patient; therapeutic drug monitoring.