meropenem and Precursor-Cell-Lymphoblastic-Leukemia-Lymphoma

Campylobacter fetus is an uncommon Campylobacter species, and its infections mainly cause infective endocarditis, aortic aneurysm, and meningitis rather than enteritis. It is more likely to be detected in blood than Campylobacter jejuni or Campylobacter coli, specifically reported in 53% of patients. In our case, C. fetus was detected in both blood and cerebrospinal fluid (CSF) cultures.. A 33-year-old woman, who was on maintenance chemotherapy for acute lymphoblastic leukemia (ALL), presented to our clinic with chief complaints of severe headache and nausea. Blood and CSF cultures revealed C. fetus. We administrated meropenem 2 g intravenously (IV) every 8 h for 3 weeks, and she was discharged without neurological sequelae.. We encountered a case of C. fetus meningitis without gastrointestinal symptoms, neck stiffness or jolt accentuation in a patient with ALL. Undercooked beef was considered the source of C. fetus infection in this case, suggesting that the need for a neutropenic diet and safe food handling be considered.

Topics: Adult; Anti-Bacterial Agents; Campylobacter fetus; Campylobacter Infections; Ceftriaxone; Diagnosis, Differential; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Female; Foodborne Diseases; Humans; Meningitis, Bacterial; Meropenem; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome

Topics: Betacoronavirus; Coronavirus Infections; COVID-19; Drug Combinations; Fatal Outcome; Female; Humans; Lopinavir; Meropenem; Middle Aged; Pandemics; Pneumonia, Viral; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Ritonavir; SARS-CoV-2; Teicoplanin

Chemotherapy of paediatric haematological malignancies can induce infectious complications of the gastrointestinal tract, with predilection of the ileocaecal region. Common causes of right lower abdominal pain in the febrile patient with neutropaenia include acute appendicitis, typhlitis, ileus and intussusception. In this case report, we describe a teenage boy with acute appendicitis presenting with pneumoperitoneum during his course of chemotherapy. The incidence, aetiology, diagnosis, investigations and management of this uncommon presentation in a common disease are discussed. The controversial topic of the management of acute appendicitis in a febrile patient with neutropaenia is also reviewed and discussed.

Topics: Abdominal Pain; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Appendectomy; Appendicitis; Child; Diagnosis, Differential; Fever; Humans; Laparoscopy; Laparotomy; Male; Meropenem; Pneumoperitoneum; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Thienamycins; Treatment Outcome

One of the first-line drugs for empirical antibiotic therapy in patients with hospital-acquired infections is meropenem. An often neglected problem in sepsis is that patients with a normal serum creatinine concentration (SCr) might display augmented renal clearance (ARC). Here we describe two cases of sepsis with subtherapeutic exposures with standard meropenem dosing in whom therapy could be optimised by therapeutic drug monitoring (TDM). A 37-year-old man with acute lymphatic leukaemia and sepsis had a normal SCr at the beginning of his Intensive Care Unit (ICU) stay but showed decreased SCr of between 30 μmol/L and 40 μmol/L during his stay. He failed to achieve effective plasma concentrations with the meropenem standard dose of 3 g/day. Estimated glomerular filtration rate revealed values between 120 mL/min and 160 mL/min. He required a high meropenem daily dosage of 12 g that was far above the approved maximum dose. A 66-year-old patient undergoing surgery of a pulmonary aspergilloma presented SCr persistently <50 μmol/L, indicating ARC between 120 mL/min and 150 mL/min. This patient required 8 g of meropenem to achieve effective plasma concentrations. TDM may represent an invaluable approach to optimising drug exposure of β-lactam antibiotics in patients with ARC in the ICU. Further trials are clearly needed to become better informed about empirical dosing regimens usable in the ICU setting with regard to the relevance of ARC. In the meantime, daily measurement of creatinine clearance as well as TDM can be used to identify patients who manifest ARC, thereby allowing drug therapy to achieve the therapeutic range.

Topics: Adult; Aged; Anti-Bacterial Agents; Drug Monitoring; Humans; Intensive Care Units; Male; Meropenem; Metabolic Clearance Rate; Plasma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sepsis; Thienamycins

Topics: Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Child, Preschool; Drug Therapy, Combination; Female; Humans; Klebsiella Infections; Klebsiella oxytoca; Meropenem; Netilmicin; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Proctitis; Thienamycins; Tomography, X-Ray Computed; Typhlitis; Vancomycin