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. 2024 Oct 30:15:1347306.
doi: 10.3389/fphar.2024.1347306. eCollection 2024.

First case report of a vertebral osteomyelitis caused by carbapenem-resistant Enterobacter cloacae treated with imipenem/cilastatin/relebactam prolonged infusion then meropenem/vaborbactam in continuous infusion

Paul Laffont-Lozes  1 , Tayma Naciri  2 , Alix Pantel  3   4 , Aurélie Martin  2 , Anne-Sophie Pruvot-Occean  5 , Vincent Haignere  6 , Paul Loubet  2   4 , Albert Sotto  2   4 , Romaric Larcher  2   7
Affiliations

First case report of a vertebral osteomyelitis caused by carbapenem-resistant Enterobacter cloacae treated with imipenem/cilastatin/relebactam prolonged infusion then meropenem/vaborbactam in continuous infusion

Paul Laffont-Lozes et al. Front Pharmacol. .

Abstract

Introduction: Bone and joint infections (BJIs) caused by multidrug-resistant bacteria are becoming more frequent. However, data on the use of novel β-lactam/β-lactamase inhibitors, such as imipenem/cilastatin/relebactam (I-R) and meropenem/vaborbactam (MVB), to treat BJIs is lacking. Furthermore, prolonged infusions of these β-lactams should theoretically optimize pharmacokinetic/pharmacodynamics target in these indications, but there are currently no reports on this type of infusions, especially in the setting of BJI.

Case presentation: We report a case of a vertebral osteomyelitis caused by carbapenem-resistant Enterobacter cloacae successfully treated with extended-infusion of I-R (1.25 g q6h over 2 h), then with continuous infusion of MVB (2 g q4h as over 4 h). Therapeutic drug monitoring confirmed that extended-infusion of I-R and continuous infusion of MVB achieved serum concentrations up to 12 mg/L of imipenem and 19 mg/L of meropenem, respectively.

Conclusion: The favourable outcome of this patient treated for a vertebral osteomyelitis caused by carbapenem-resistant E. cloacae suggest that extended- and continuous infusions of I-R and MVB, are promising regimens for treatment of BJIs caused by carbapenem-resistant Enterobacterales.

Keywords: bone and joint infection; continuous infusion; extended infusion; imipenem/cilastatin/relebactam; meropenem/vaborbactam; therapeutic drug monitoring; vertebral osteomyelitis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Medullar magnetic resonance imaging: Decreased height and STIR hypersignal of disc (white arrow) with irregularity and erosion of T11-T12 vertebral body endplates (white dotted arrow), and epidural collections (white dashed arrow).
FIGURE 2
FIGURE 2
Therapeutic drug monitoring of imipenem and meropenem plasma concentrations in the patient. Imipenem through concentrations are represented by black circles and meropenem steady-state concentrations are represented by black triangles. Creatinine clearance is represented by black circles and dotted line, and C-reactive protein (CRP) is represented by black squares and dotted line.
See this image and copyright information in PMC

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