Burn Injury and Augmented Renal Clearance: A Case for Optimized Piperacillin-Tazobactam Dosing

J Burn Care Res. 2023 Jan 5;44(1):203-206. doi: 10.1093/jbcr/irac138.

Abstract

Patients with burn injuries are at high risk for infection as well as altered antimicrobial pharmacokinetics. Patients suffering from a burn injury, generally encompassing a total body surface area (TBSA) ≥ 20%, have been cited as at risk for augmented renal clearance (ARC). Our case report describes an obese patient with 3.2% TBSA partial thickness burns who suffered from burn wound cellulitis with Pseudomonas aeruginosa. Measured CLcr documented the presence of ARC, and 22.5 grams daily continuous infusion of piperacillin-tazobactam was initiated. Therapeutic monitoring of piperacillin at steady state was 78 mcg/mL, achieving the prespecified goal piperacillin concentration of 100% 4-times the minimum inhibitory concentration assuming MIC for susceptible P. aeruginosa at 16/4 mcg/mL per Clinical Laboratory Standards Institute. Available literature suggests younger critically ill patients with lower organ failure scores, and for a burn injury, a higher percentage of TBSA, are most likely to exhibit ARC which does not entirely align with the characteristics of our patient. In addition, piperacillin-tazobactam has been associated with altered pharmacokinetics in ARC, burn, and obese populations, demonstrating failure to meet target attainment with standard doses. We suggest a continuous infusion of piperacillin-tazobactam be used when ARC is identified. This case report describes the unique findings of ARC in a non-critically ill burn patient and rationalizes the need for further prospective research to classify incidence, risk factors, and appropriate antimicrobial regimens for burn patients with ARC.

Keywords: Pseudomonas aeruginosa; Augmented renal clearance; Burn; Continuous infusion; Piperacillin-tazobactam.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Bacterial Agents
  • Burns* / complications
  • Burns* / drug therapy
  • Critical Illness / therapy
  • Humans
  • Microbial Sensitivity Tests
  • Piperacillin* / pharmacokinetics
  • Piperacillin, Tazobactam Drug Combination
  • Tazobactam

Substances

  • Piperacillin
  • Tazobactam
  • Anti-Bacterial Agents
  • Piperacillin, Tazobactam Drug Combination