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

• Published in: Frontiers in pharmacology Vol. 15; p. 1347306
• Main Authors: Laffont-Lozes, Paul, Naciri, Tayma, Pantel, Alix, Martin, Aurélie, Pruvot-Occean, Anne-Sophie, Haignere, Vincent, Loubet, Paul, Sotto, Albert, Larcher, Romaric
• Format: Journal Article
• Language: English
• Published: Frontiers 30-10-2024; Frontiers Media S.A
• Subjects: bone and joint infection; continuous infusion; extended infusion; imipenem/cilastatin/relebactam; Life Sciences; meropenem/vaborbactam; Pharmacology; vertebral osteomyelitis
• ISSN: 1663-9812; 1663-9812
• DOI: 10.3389/fphar.2024.1347306

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.