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...
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| Format: | Article |
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2021.728075/full |
| _version_ | 1818719012232626176 |
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| author | Marcus Fransson Anders Helldén Åse Östholm Balkhed Dženeta Nezirević Dernroth Maria Ha Mats Haglund Peter Milos Håkan Hanberger Bertil Kågedal |
| author_facet | Marcus Fransson Anders Helldén Åse Östholm Balkhed Dženeta Nezirević Dernroth Maria Ha Mats Haglund Peter Milos Håkan Hanberger Bertil Kågedal |
| author_sort | Marcus Fransson |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-17T20:00:10Z |
| format | Article |
| id | doaj.art-aa066619e31c45db8ca574790da9a1a9 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-17T20:00:10Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-aa066619e31c45db8ca574790da9a1a92022-12-21T21:34:29ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122021-10-011210.3389/fphar.2021.728075728075Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermediusMarcus Fransson0Anders Helldén1Åse Östholm Balkhed2Dženeta Nezirević Dernroth3Maria Ha4Mats Haglund5Peter Milos6Håkan Hanberger7Bertil Kågedal8Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Clinical Chemistry and Clinical Pharmacology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Clinical Chemistry and Clinical Pharmacology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Infectious Diseases, Kalmar County Hospital, Kalmar, SwedenDepartment of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Clinical Chemistry and Clinical Pharmacology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenStreptococcus 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.https://www.frontiersin.org/articles/10.3389/fphar.2021.728075/fullsuboptimal antibiotic treatmenttubular cell membrane transportersglomerular filtration rateaugmented renal clearancevancomycin clearanceiohexol clearance |
| spellingShingle | Marcus Fransson Anders Helldén Åse Östholm Balkhed Dženeta Nezirević Dernroth Maria Ha Mats Haglund Peter Milos Håkan Hanberger Bertil Kågedal Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius Frontiers in Pharmacology suboptimal antibiotic treatment tubular cell membrane transporters glomerular filtration rate augmented renal clearance vancomycin clearance iohexol clearance |
| 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 | suboptimal antibiotic treatment tubular cell membrane transporters glomerular filtration rate augmented renal clearance vancomycin clearance iohexol clearance |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2021.728075/full |
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