Objective:

To describe the real-world use of aztreonam/avibactam in a critically ill patient with end-stage renal disease undergoing continuous venovenous haemodiafiltration (CVVHDF) for an NDM-producing Klebsiella pneumoniae infection.

Approach:

• Case Presentation: A 76-year-old woman with a history of chronic renal failure and recurrent urinary tract infections was treated with aztreonam/avibactam after being transferred for surgical intervention. She was anuric and undergoing continuous venovenous haemodiafiltration (CVVHDF).
• Treatment Protocol: Aztreonam/avibactam was administered with a loading dose of 1 g/0.333 g followed by continuous infusion of 0.675 g/0.225 g every 12 hours, adjusted for renal impairment and CVVHDF.

Key Findings:

• The patient was colonized with NDM-producing Klebsiella pneumoniae but did not show microbiological evidence of infection post-surgery.
• Aztreonam/avibactam was successfully used in a continuous infusion regimen during CVVHDF to maintain therapeutic drug levels.

Limitations:

• Limited pharmacokinetic data on aztreonam/avibactam in the context of CVVHDF.
• Absence of microbiological confirmation of NDM infection during treatment.

Sources:

• Fresán et al. study on CVVHDF and aztreonam/avibactam