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Pseudomonas Pneumonia — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipPseudomonas PneumoniaSCE Infectious Diseases

A 55-year-old woman develops severe hospital-acquired pneumonia on day 12 of her ICU admission. She has been on Piperacillin/Tazobactam for an intra-abdominal infection. Tracheal aspirate grows Pseudomonas aeruginosa resistant to Piperacillin/Tazobactam and Ciprofloxacin but sensitive to Meropenem (MIC 2 mg/L), Ceftazidime, and Colistin. What is the optimal Meropenem dosing strategy?

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Correct answer: A — Meropenem 2 g TDS as a 3-hour prolonged infusion

For Pseudomonas with Meropenem MIC of 2 mg/L (susceptible but at higher end), optimised dosing is important. Meropenem 2 g TDS administered as a 3-hour prolonged infusion (or continuous infusion) maximises the %fT>MIC, which is the pharmacodynamic target for beta-lactams. The BLING III trial demonstrated mortality benefit with continuous/extended beta-lactam infusion in critically ill patients. Standard bolus dosing may result in subtherapeutic drug levels against organisms with higher MICs.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections