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Abstract

Crit Care Med 2014 • Volume 42 • 12 (Suppl.) for the admission. On HD6-7 she was placed on ECLS for lung protection and to facilitate fluid removal. On HD 7 she was initiated on CRRT. On HD 12, a blood culture returned positive and subsequently grew Pseudomonas aeruginosa with a minimum inhibitory concentration for meropenem of 0.25 mcg/mL. As a result of the positive blood culture, she was initiated on a regimen of vancomycin, meropenem, and amikacin. Meropenem was started with a 40 mg/kg bolus given over 30 minutes after which a continuous infusion of 10 mg/kg/hour (240 mg/ kg/day) was initiated. On HD 15 (ECLS day 9) a meropenem of 21 mcg/mL was obtained, corresponding to a clearance of 7.9 mL/kg/minute, drastically higher compared with 4 mL/kg/min reported in the package insert. Repeat cultures from HD 13-15 (ECLS day 7-9) were sterile. Conclusion A meropenem regimen of a 40 mg/kg bolus followed by a continuous infusion of 240 mg/kg/day was successful in providing a target attainment of 100% for serum concentrations above the MIC for at least 40% of the dosing interval and was associated with a sterilization of blood in this complex patient on concurrent ECLS and CRRT circuits.