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Case Reports
. 2025 Jun;45(6):386-392.
doi: 10.1002/phar.70019. Epub 2025 Apr 15.

Pharmacokinetics of continuous infusion ceftolozane/tazobactam in two patients with extensive total body surface area burns

Jay D Olivet  1 , Megan Amerson-Brown  2 , Juan J Calix  3 , Emma Graffice  3   4 , Tyson Kilpatrick  1 , Hanna F Roenfanz  5 , David P Nicolau  5 , Joseph L Kuti  5 , Matthew L Brown  1
Affiliations
Case Reports

Pharmacokinetics of continuous infusion ceftolozane/tazobactam in two patients with extensive total body surface area burns

Jay D Olivet et al. Pharmacotherapy. 2025 Jun.

Abstract

Introduction: Treatment of infections in patients with burn injuries is challenging due to altered antimicrobial pharmacokinetics. Continuous infusion β-lactam therapy may be a useful antimicrobial stewardship strategy to improve pharmacodynamic target attainment in this population.

Case summaries: This report highlights the use of continuous infusion ceftolozane/tazobactam (C/T) in two patients with extensive total body surface area (TBSA) burns, suspected augmented renal clearance (ARC), and bloodstream infections caused by Pseudomonas aeruginosa with difficult-to-treat resistance (DTR P. aeruginosa). Both patients received C/T 9 g/day via continuous infusion. Minimum inhibitory concentrations (MIC) of C/T were 8/4 and 4/4 μg/mL in Cases 1 and 2, respectively.

Discussion: Despite similar patient characteristics, average free plasma ceftolozane concentrations were 41.6 mg/L in Case 1 and 22.8 mg/L in Case 2. Measured free concentrations exceeded 4 times the MIC for 100% of each 24-h infusion (fT > 4xMIC), and bacteremia was successfully cleared in each case.

Conclusion: These cases highlight the variability of drug exposure in patients with extensive TBSA burn injuries and support continuous infusion β-lactam therapy as a proactive strategy to optimize pharmacodynamic target attainment when pharmacokinetics are unpredictable.

Keywords: Pseudomonas aeruginosa; antimicrobial stewardship; burns; ceftolozane tazobactam; continuous infusion; multidrug‐resistant; pharmacokinetics.

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Conflict of interest statement

Megan Amerson‐Brown received research funding from Selux diagnostics. David P. Nicolau and Joseph L. Kuti received research funding from Merck&Co. Dr. Kuti is a member of the Pharmacotherapy editorial board. All other authors declare no conflicts of interest.

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