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Plazomicin for the treatment of multidrug-resistant Klebsiella bacteraemia in a patient with underlying chronic kidney disease and acute renal failure requiring renal replacement therapy
  1. William Earle1,2,
  2. Ramón G B Bonegio1,3,
  3. Donald B Smith4 and
  4. Westyn Branch-Elliman5,6
  1. 1Department of Medicine, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
  2. 2Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  4. 4Department of Pharmacy, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
  5. 5Department of Medicine, Section of Infectious Diseases, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
  6. 6Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr William Earle; wearle{at}bidmc.harvard.edu

Abstract

A 75-year-old man presented with shortness of breath and somnolence and was found to have urosepsis. Blood and urine cultures subsequently grew multidrug-resistant (MDR) Klebsiella pneumoniae (Kp) with the New Delhi metallo-β-lactamase gene. The patient was treated successfully with plazomicin and meropenem/vaborbactam combination therapy. The course was complicated by acute kidney injury temporarily requiring haemodialysis, gastrointestinal bleed requiring multiple transfusions and hospital readmission with blood cultures again positive with MDR Kp. Plazomicin drug levels were persistently high during treatment, suggesting that therapeutic drug monitoring may be needed to safely use this drug in patients with severe renal dysfunction. This case marks the first use of plazomicin for bacteraemia in the literature outside of a clinical trial and demonstrates its safe and effective use in a patient with advanced renal disease, and provides important insights about dosing and therapeutic drug monitoring considerations in this patient population.

  • urinary tract infections
  • acute renal failure
  • infections
  • safety

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Footnotes

  • Contributors WE and WB-E conceived of the project. WE conducted a literature review, collected data and took the lead in writing the manuscript. WB-E, RGBB and DBS assisted with the data analysis and interpretation. All authors provided critical feedback and helped shape the analysis and manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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