Assiya Kadralinova

This case report highlights the use of continuous infusion of meropenem in a 42-year-old septic female patient with periprosthetic infection and end-stage renal disease receiving prolonged intermittent renal replacement therapy (PIRRT). Antibiotic infusion in patients receiving renal replacement therapy has its own peculiarities. There are many studies on the optimal dosing regimen for meropenem in renal dysfunction, but studies on the optimal infusion duration in these patients are limited. The patient was admitted with complaints of wounds, necrosis zones of the right upper limb, restriction of joint movements, and temperature increase up to 38 °C. The patient was treated with a continuous infusion of meropenem 2 g per day receiving renal replacement therapy three times a week (12 h). Also during hospitalization, the patient underwent hip disarticulation and excision of necrotic tissues. The patient was further transferred to a specialized nephrology department for further treatment. We believe that in this clinical case, the use of continuous infusion of meropenem in the complex therapy of sepsis in a patient with CKD undergoing PIRRT sessions helped to lead to clinical improvement in the patient. Further studies are needed.

Меропенемнің үздіксіз инфузиясы сепсисті емдеуге арналған нұсқауларда ұсынылады. Дегенмен, меропенемнің ұзартылған инфузиясын қолдану азық-түлік және дәрі-дәрмек басқармасы (FDA) тарапынан мақұлданбаған және «белгіден тыс» пайдалану болып саналады. Сонымен қатар, кейбір зерттеулер үзіліссіз инфузияларға қарағанда үзіліссіз инфузиялардың пайдасы туралы қарама-қайшы дәлелдерді береді. Жас сепсис пен септикалық шокпен ауыратын науқастардағы өлімнің тәуелсіз болжаушысы екені белгілі.Бұл зерттеуде біз травматология және ортопедиядағы сепсиспен ауыратын гериатриялық науқастарда үздіксіз инфузияның тиімділігін бағаладық.Бұл 2021 жылдың қарашасынан 2023 жылдың наурызына дейін үздіксіз инфузиялық меропенемді қабылдаған сепсиспен ауыратын 7 гериатриялық жарақат алған пациенттерді қамтитын бір орталықты жағдайлар сериясы болды. Бұл зерттеудіңмақсаты сепсиспен ауыратын егде жастағы емделушілерде меропенемді үздіксіз инфузиялаудың орындылығын және клиникалық әсерін бағалау болып табылады. Клиникалық нәтижелерді, зертханалық параметрлерді, асқынуларды және ауруханадан шыққанға дейін тірі қалуды қамтитын деректер де жиналды. Барлығы 7 пациент (орташа жасы 71 жас, әйелдер 100%) меропенемніңүздіксіз инфузиясын алды. Барлық науқастар инфузия алдында септикалық болды. Бір науқас басқа ауруханаға ауыстырылды, онданауқастың өлімі кейіннен тіркелді, 6 науқас ауруханадан шыққанға дейін аман қалды, 1 науқас ауруханадан шығарылғаннан кейінқайтыс болды. 2 науқаста көп дәріге төзімді бактериялар байқалды.Қорытынды. Меропенемнің үздіксіз инфузиясын қолдану клиникалық жақсартуға әкелуі мүмкін, бірақ өлімді төмендетпейді.

This article highlights a case of high-dose ferric carboxymaltose (Ferinject^®) for the treatment of perioperative iron deficiency anaemia in a 39-year-old patient with dysplastic coxarthrosis. The patient was admitted routinely for a total hip replacement of the left hip joint. She had been suffering from pain, lameness, and restriction of movement in her left hip joint for the past several years. The patient was admitted with initial iron deficiency anaemia of a medium severity (Hgb—96.5 g/L, RBC—3.97 × 10¹²/L). Laboratory tests were taken to determine the iron deficiency, and transfusion readiness was submitted. The patient received ferric carboxymaltose infusion before surgery. The intraoperative blood loss was—100 mL with an operation duration of 50 min. On the first postoperative day, haemoglobin decreased to 86 g/L. No haemoglobin decrease was observed in the postoperative period, and 92 g/L was the amount of haemoglobin at the time of hospital discharge. The optimal dose for the treatment of perioperative anaemia has not been established; some studies recommend ferric carboxymaltose at a dose of 15 to 20 mg/kg and a maximum of 1000 mg once on the first day after surgery. The uniqueness of this case report is that a high dose of ferric carboxymaltose (1340 mg) during the preoperative period was applied. No side effects such as hypophosphatemia were reported. We believe that, in this clinical case, the patient managed to avoid large intraoperative blood loss and transfusions by using high doses of ferric carboxymaltose.

Background and Objectives: The prolonged infusion of meropenem is recommended by guidelines for the treatment of sepsis. However, studies provide controversial data on the advantages of prolonged infusions over intermittent ones. In our opinion, this can be related to age, which possibly distorts the final data, as older people have age-related characteristics. In our study, we analyzed the ventilatory status, laboratory tests and vital signs of the patient and carried out microbiological cultures. Materials and Methods: This was a prospective single-center case series investigation conducted from June 2022 to June 2023. The objective of this study was to evaluate the effectiveness of continuous infusion in elderly patients with severe infectious complications after orthopedic interventions. The primary endpoints were 28-day survival and the emergence of new multidrug-resistant strains. Secondary endpoints were long-term mortality and length of stay in the ICU. Results: Three patients (median age 65, 100% female) received a continuous infusion of meropenem. Two patients were alive at hospital discharge, and one patient died on the 105th day of hospitalization. Multi-resistant bacteria were observed in one patient. Conclusions: The use of a continuous meropenem infusion in the complex treatment of purulent-septic complications in elderly patients with periprosthetic infection and anemia probably led to clinical improvement in these case reports. However, the emergence of new pan-resistant strains and overall mortality using this infusion technique remains unclear. Further, high-quality RCTs for the elderly are needed.

This article highlights a clinical case of successful treatment of a 79-year-old multimorbid patient with a hip fracture resulting from a household injury. On the first day, the patient’s injury was complicated by infection and pneumonia. As a result, arterial hypotension, tachysystole, and respiratory failure progressed. With manifestations of sepsis, the patient was transferred to the intensive care unit. Surgical treatment in such a situation was contraindicated due to the high operational and anesthesiological risks, the unstable severe condition of the patient, as well as the presence of concomitant pathology in the form of coronary heart disease, obesity, and schizophrenia. According to the new sepsis management guideline, it was decided to use a continuous 24-h infusion of meropenem in addition to the complex treatment of sepsis. The use of continuous infusion of meropenem in this clinical situation may have caused the patient’s clinical improvement, which increased her quality of life and decreased the length of ICU stay and total hospital stay, despite an unfavorable cumulative prognosis and a high risk of in-hospital mortality.