Plasma and renal cortex meropenem concentrations in patients undergoing percutaneous renal biopsy

Abstract

Background. Urinary tract infection (UTI) is the most common bacterial infection in the world. Some cases can have serious complication as death by septic shock. With the increasing spread of multidrug-resistant bacteria, the therapeutic possibilities against the complicated UTI are exhausted, forcing the use of broad-spectrum antibiotics such as meropenem. Objectives. To evaluate the penetrating ability of meropenem to renal tissue using an enzymatic biosensor in samples of renal cortex and its correlation with plasma levels. Method. We conducted a descriptive study in humans with indication of kidney biopsy. Meropenem was administered 1 hour before performing the biopsy, and the concentrations of meropenem in a series of samples of plasma and renal biopsy were determined. Results. Renal biopsy and plasma samples of 14 patients, 64% women with body mass index of 26.3 kg/m(2) (SD +/- 2.9) and estimated glomerular filtration rate of 57.5 mL/min/1.73 m(2) (SD +/- 44.1), were examined. Renal biopsy was done at 68.9 minutes (SD +/- 20.3), and the second plasma sample was obtained at 82.1 minutes (SD +/- 21.2) and the third at 149.6 minutes (SD +/- 31.5). The mean kidney meropenem concentration was 3.1 mu g/mL (SD +/- 1.9). For each patient, a decay curve of plasma meropenem concentration was constructed. The proportion of meropenem concentrations in renal tissue and plasma at biopsy moment was 14% (SD +/- 10) with an interquartile range of 5.5-20.3%. With normal renal function, meropenem can achieve a bactericidal effect towards bacteria with MIC-90 < 0.76 mu g/mL in the renal parenchyma. Conclusions. Meropenem is effective to treat the most frequent uropathogens with the bactericidal effect. Nevertheless, for resistant bacteria, it is necessary to adjust the dose to achieve adequate parenchymal concentration.