Aztreonam/avibactam during continuous venovenous haemodiafiltration in a critically ill patient with NDM-producing Klebsiella pneumoniae: a case report and review of the literature - Scorecard - MDSpire
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Use of Aztreonam/Avibactam in Continuous Venovenous Haemodiafiltration for a Critically Ill Patient Infected with NDM-Producing Klebsiella pneumoniae: A Case Study and Literature Review
Clinical Scorecard: Use of Aztreonam/Avibactam in Continuous Venovenous Haemodiafiltration for a Critically Ill Patient Infected with NDM-Producing Klebsiella pneumoniae: A Case Study and Literature Review
At a Glance
Category
Detail
Condition
Carbapenem-resistant Enterobacterales infections
Key Mechanisms
Aztreonam is stable against MBLs; avibactam protects aztreonam from serine β-lactamases.
Target Population
Critically ill patients with end-stage renal disease and NDM-producing Klebsiella pneumoniae infections.
Care Setting
Intensive care unit with continuous renal replacement therapy.
Key Highlights
Aztreonam/avibactam shows promise for treating MBL-producing Gram-negative infections.
Dosing adjustments are necessary in patients undergoing continuous renal replacement therapy.
Continuous infusion of aztreonam/avibactam can maintain therapeutic drug levels.
Guideline-Based Recommendations
Diagnosis
Confirm NDM-producing Klebsiella pneumoniae through rectal screening.
Management
Initiate aztreonam/avibactam based on renal function and infection severity.
Monitoring & Follow-up
Monitor drug levels to ensure unbound aztreonam exceeds 8 mg/L and avibactam exceeds 2.5 mg/L.
Risks
Increased clearance of aztreonam and avibactam during continuous renal replacement therapy may necessitate dosing adjustments.
Patient & Prescribing Data
Anuric patients undergoing chronic haemodialysis.
Utilize a loading dose followed by continuous infusion to maintain therapeutic levels.
Clinical Best Practices
Use population pharmacokinetic data to guide dosing in renal impairment.
Consider continuous infusion for critically ill patients to optimize drug exposure.
