Success With Extended-Infusion Meropenem After Recurrence of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis in an Adolescent

J Pharm Pract. 2015 Aug;28(4):430-3. doi: 10.1177/0897190015585757. Epub 2015 Jun 1.


A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). Meropenem serum concentrations were obtained and indicated that T>MIC was at least 75% of the dosing interval. Our patient improved with no noted recurrences or adverse effects on the extended-infusion meropenem regimen. Utilization of extended-infusion beta-lactam dosing whenever possible in the treatment of serious infections caused by gram-negative organisms should be considered, as this dosing appears to be safe and improves the probability of achieving pharmacokinetic/pharmacodynamic goals.

Keywords: Achromobacter; device infection; meningitis; meropenem; pharmacodynamics.

Publication types

  • Case Reports

MeSH terms

  • Achromobacter denitrificans / isolation & purification*
  • Adolescent
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Baclofen / administration & dosage*
  • Drug Administration Schedule
  • Female
  • Gram-Negative Bacterial Infections / drug therapy
  • Gram-Negative Bacterial Infections / etiology
  • Gram-Negative Bacterial Infections / microbiology
  • Humans
  • Infusion Pumps, Implantable / adverse effects
  • Injections, Spinal
  • Meningitis, Bacterial / drug therapy*
  • Meningitis, Bacterial / etiology
  • Meningitis, Bacterial / microbiology
  • Meropenem
  • Microbial Sensitivity Tests
  • Muscle Relaxants, Central / administration & dosage
  • Recurrence
  • Thienamycins / administration & dosage*
  • Thienamycins / therapeutic use


  • Anti-Bacterial Agents
  • Muscle Relaxants, Central
  • Thienamycins
  • Meropenem
  • Baclofen