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  • Snapshot
    • A 65-year-old man is admitted to the medical intensive care unit for management of sepsis. He was started on empiric antibiotic treatment with vancomycin and piperacillin-tazobactam after blood cultures were obtained. His temperature is 102°F (38.9°C), blood pressure is 79/65 mmHg, pulse is 120/min, and respirations are 22/min. Blood culture grow Pseudomonas aeruginosa which is sensitive to meropenem and his antibiotics are narrowed.
  • Introduction
    • Mechanism of action
      • binds to penicillin-binding proteins (PBPs) inhibiting transpeptidation
        • impairs peptidoglycan synthesis, a needed component of cell wall biosynthesis
    • Mechanism of resistance
      • carbapenemase production
      • altered PBPs
    • Drugs
      • doripenem
      • imipenem
        • must be administered with cilastatin (a renal dehydropeptidase I inhibitor) to prevent its metabolism in the renal tubules
      • meropenem
      • ertapenem
    • Clinical use
      • gram-positive cocci
      • gram-negative rods
      • anaerobes
      • preferably used in the setting of a life-threatening infection or when other antibiotic therapies have failed
    • Adverse effects
      • seizures
        • meropenem is the carbapenem that has a decreased risk of seizure
      • gastrointestinal distress
      • rash
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