Cargando…

Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius

Streptococcus intermedius occasionally causes brain abscesses that can be life-threatening, requiring prompt antibiotic and neurosurgical treatment. The source is often dental, and it may spread to the eye or the brain parenchyma. We report the case of a 34-year-old man with signs of apical periodon...

Descripción completa

Detalles Bibliográficos
Autores principales: Fransson, Marcus, Helldén, Anders, Östholm Balkhed, Åse, Nezirević Dernroth, Dženeta, Ha, Maria, Haglund, Mats, Milos, Peter, Hanberger, Håkan, Kågedal, Bertil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527190/
https://www.ncbi.nlm.nih.gov/pubmed/34690767
http://dx.doi.org/10.3389/fphar.2021.728075
_version_ 1784586028217008128
author Fransson, Marcus
Helldén, Anders
Östholm Balkhed, Åse
Nezirević Dernroth, Dženeta
Ha, Maria
Haglund, Mats
Milos, Peter
Hanberger, Håkan
Kågedal, Bertil
author_facet Fransson, Marcus
Helldén, Anders
Östholm Balkhed, Åse
Nezirević Dernroth, Dženeta
Ha, Maria
Haglund, Mats
Milos, Peter
Hanberger, Håkan
Kågedal, Bertil
author_sort Fransson, Marcus
collection PubMed
description Streptococcus intermedius occasionally causes brain abscesses that can be life-threatening, requiring prompt antibiotic and neurosurgical treatment. The source is often dental, and it may spread to the eye or the brain parenchyma. We report the case of a 34-year-old man with signs of apical periodontitis, endophthalmitis, and multiple brain abscesses caused by Streptococcus intermedius. Initial treatment with meropenem and vancomycin was unsuccessful due to subtherapeutic concentrations, despite recommended dosages. Adequate concentrations could be reached only after increasing the dose of meropenem to 16 g/day and vancomycin to 1.5 g × 4. The patient exhibited high creatinine clearance consistent with augmented renal clearance, although iohexol and cystatin C clearances were normal. Plasma free vancomycin clearance followed that of creatinine. A one-day dose of trimethoprim–sulfamethoxazole led to an increase in serum creatinine and a decrease in both creatinine and urea clearances. These results indicate that increased tubular secretion of the drugs was the cause of suboptimal antibiotic treatment. The patient eventually recovered, but his left eye needed enucleation. Our case illustrates that augmented renal clearance can jeopardize the treatment of serious bacterial infections and that high doses of antibiotics are needed to achieve therapeutic concentrations in such cases. The mechanisms for regulation of kidney tubular transporters of creatinine, urea, vancomycin, and meropenem in critically ill patients are discussed.
format Online
Article
Text
id pubmed-8527190
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-85271902021-10-21 Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius Fransson, Marcus Helldén, Anders Östholm Balkhed, Åse Nezirević Dernroth, Dženeta Ha, Maria Haglund, Mats Milos, Peter Hanberger, Håkan Kågedal, Bertil Front Pharmacol Pharmacology Streptococcus intermedius occasionally causes brain abscesses that can be life-threatening, requiring prompt antibiotic and neurosurgical treatment. The source is often dental, and it may spread to the eye or the brain parenchyma. We report the case of a 34-year-old man with signs of apical periodontitis, endophthalmitis, and multiple brain abscesses caused by Streptococcus intermedius. Initial treatment with meropenem and vancomycin was unsuccessful due to subtherapeutic concentrations, despite recommended dosages. Adequate concentrations could be reached only after increasing the dose of meropenem to 16 g/day and vancomycin to 1.5 g × 4. The patient exhibited high creatinine clearance consistent with augmented renal clearance, although iohexol and cystatin C clearances were normal. Plasma free vancomycin clearance followed that of creatinine. A one-day dose of trimethoprim–sulfamethoxazole led to an increase in serum creatinine and a decrease in both creatinine and urea clearances. These results indicate that increased tubular secretion of the drugs was the cause of suboptimal antibiotic treatment. The patient eventually recovered, but his left eye needed enucleation. Our case illustrates that augmented renal clearance can jeopardize the treatment of serious bacterial infections and that high doses of antibiotics are needed to achieve therapeutic concentrations in such cases. The mechanisms for regulation of kidney tubular transporters of creatinine, urea, vancomycin, and meropenem in critically ill patients are discussed. Frontiers Media S.A. 2021-10-06 /pmc/articles/PMC8527190/ /pubmed/34690767 http://dx.doi.org/10.3389/fphar.2021.728075 Text en Copyright © 2021 Fransson, Helldén, Östholm Balkhed, Nezirević Dernroth, Ha, Haglund, Milos, Hanberger and Kågedal. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Fransson, Marcus
Helldén, Anders
Östholm Balkhed, Åse
Nezirević Dernroth, Dženeta
Ha, Maria
Haglund, Mats
Milos, Peter
Hanberger, Håkan
Kågedal, Bertil
Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius
title Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius
title_full Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius
title_fullStr Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius
title_full_unstemmed Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius
title_short Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius
title_sort case report: subtherapeutic vancomycin and meropenem concentrations due to augmented renal clearance in a patient with intracranial infection caused by streptococcus intermedius
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527190/
https://www.ncbi.nlm.nih.gov/pubmed/34690767
http://dx.doi.org/10.3389/fphar.2021.728075
work_keys_str_mv AT franssonmarcus casereportsubtherapeuticvancomycinandmeropenemconcentrationsduetoaugmentedrenalclearanceinapatientwithintracranialinfectioncausedbystreptococcusintermedius
AT helldenanders casereportsubtherapeuticvancomycinandmeropenemconcentrationsduetoaugmentedrenalclearanceinapatientwithintracranialinfectioncausedbystreptococcusintermedius
AT ostholmbalkhedase casereportsubtherapeuticvancomycinandmeropenemconcentrationsduetoaugmentedrenalclearanceinapatientwithintracranialinfectioncausedbystreptococcusintermedius
AT nezirevicdernrothdzeneta casereportsubtherapeuticvancomycinandmeropenemconcentrationsduetoaugmentedrenalclearanceinapatientwithintracranialinfectioncausedbystreptococcusintermedius
AT hamaria casereportsubtherapeuticvancomycinandmeropenemconcentrationsduetoaugmentedrenalclearanceinapatientwithintracranialinfectioncausedbystreptococcusintermedius
AT haglundmats casereportsubtherapeuticvancomycinandmeropenemconcentrationsduetoaugmentedrenalclearanceinapatientwithintracranialinfectioncausedbystreptococcusintermedius
AT milospeter casereportsubtherapeuticvancomycinandmeropenemconcentrationsduetoaugmentedrenalclearanceinapatientwithintracranialinfectioncausedbystreptococcusintermedius
AT hanbergerhakan casereportsubtherapeuticvancomycinandmeropenemconcentrationsduetoaugmentedrenalclearanceinapatientwithintracranialinfectioncausedbystreptococcusintermedius
AT kagedalbertil casereportsubtherapeuticvancomycinandmeropenemconcentrationsduetoaugmentedrenalclearanceinapatientwithintracranialinfectioncausedbystreptococcusintermedius