What are the key points in the recovery of a 78-year-old female with a history of infected surgical site from spine surgery, multiple incision and drainage procedures, body mass index (BMI) of 40, and hypertension, who is being discharged to subacute rehabilitation with 6 weeks of intravenous (IV) meropenem via a peripherally inserted central catheter (PICC) line?

From the Guidelines

The key points in the recovery of this 78-year-old female patient include careful management of her PICC line, vigilant monitoring of her surgical site, and addressing her comorbidities of obesity and hypertension during rehabilitation, with a focus on nutritional support and physical therapy to optimize her outcomes, as supported by the principles of Enhanced Recovery after Surgery (ERAS) 1. The patient's recovery plan should prioritize the following aspects:

• Careful management of the PICC line for the 6-week course of IV meropenem, with daily assessments for signs of infection or displacement, and sterile dressing changes performed according to facility protocol.
• Vigilant monitoring of the surgical site for signs of persistent infection, such as drainage, redness, warmth, or increased pain.
• Addressing her comorbidities of obesity and hypertension during rehabilitation, with a focus on nutritional support and physical therapy to optimize her outcomes.
• Nutritional support with a balanced, protein-rich diet to promote wound healing while addressing her obesity, as emphasized in the ERAS guidelines 1.
• Physical therapy should be initiated gradually, considering her age and BMI, focusing on mobility, strength, and independence in activities of daily living.
• Blood pressure monitoring is essential due to her hypertension, with medication adjustments as needed.
• Regular laboratory monitoring, including complete blood count, renal function tests, and inflammatory markers, will help track infection resolution and detect potential antibiotic side effects.
• The rehabilitation team should also provide education on wound care, medication management, and lifestyle modifications to prevent future complications, as highlighted in the guidelines for managing complicated intra-abdominal infection 1.
• A multidisciplinary approach, including shared decision-making with patients and their caregivers, setting realistic expectations, and addressing psychosocial barriers, is crucial for effective management, as noted in the executive summary on pelvic osteomyelitis 1.

From the FDA Drug Label

The following adverse reaction frequencies were derived from the clinical trials in the 2904 patients treated with Meropenem for injection (I.V.) Local Adverse Reactions Local adverse events that were reported with Meropenem for injection (I.V.) were as follows: Inflammation at the injection site 2.4% Injection site reaction 0.9% Phlebitis/thrombophlebitis 0.8% Pain at the injection site 0. 4% Edema at the injection site 0.2% Systemic Adverse Reactions Systemic adverse events that were reported with Meropenem for injection (I.V.) occurring in greater than 1% of the patients were diarrhea (4.8%), nausea/vomiting (3.6%), headache (2.3%), rash (1.9%), sepsis (1.6%), constipation (1.4%), apnea (1.3%), shock (1.2%), and pruritus (1. 2%).

The key points in the recovery of a 78-year-old female with a history of infected surgical site from spine surgery, multiple incision and drainage procedures, body mass index (BMI) of 40, and hypertension, who is being discharged to subacute rehabilitation with 6 weeks of intravenous (IV) meropenem via a peripherally inserted central catheter (PICC) line are:

• Monitoring for local adverse reactions at the injection site, such as inflammation, injection site reaction, phlebitis/thrombophlebitis, pain, and edema.
• Monitoring for systemic adverse reactions, such as diarrhea, nausea/vomiting, headache, rash, sepsis, constipation, apnea, shock, and pruritus.
• Watching for signs of superinfection or overgrowth of nonsusceptible organisms, as prolonged use of meropenem may result in these complications 2.
• Regular evaluation of the patient to assess the effectiveness of the treatment and to detect any potential adverse reactions early on.
• Caution with regards to operating machinery or motorized vehicles, as meropenem may cause adverse events such as seizures, delirium, headaches, and/or paresthesias that could interfere with mental alertness and/or cause motor impairment 2.

From the Research

Key Points in Recovery

• The patient's recovery from an infected surgical site after spine surgery will depend on several factors, including the effectiveness of the antibiotic treatment with meropenem 3.
• Meropenem is a broad-spectrum antibacterial agent that has been shown to be effective in treating serious bacterial infections, including those caused by Gram-positive and Gram-negative pathogens 3.
• The patient's high body mass index (BMI) of 40 may affect the pharmacokinetics of meropenem, but studies have shown that meropenem can be effective in patients with high BMI 4.
• The use of a peripherally inserted central catheter (PICC) line for administration of meropenem may be associated with a risk of complications, such as infection or thrombosis, and should be monitored closely 5.
• The patient's hypertension may also affect the pharmacokinetics of meropenem, and blood pressure should be monitored closely during treatment 5.
• Studies have shown that meropenem can be effective in treating infections in patients with multiple incision and drainage procedures, but the patient's individual response to treatment should be monitored closely 6.

Monitoring and Follow-up

• The patient's response to meropenem treatment should be monitored closely, including regular checks of vital signs, laboratory results, and clinical symptoms 7.
• The patient's renal function should be monitored closely, as meropenem can affect kidney function, especially in patients with pre-existing kidney disease 4.
• The patient's surgical site should be monitored closely for signs of infection or other complications, and wound care should be provided as needed 6.

Potential Complications

• The patient may be at risk for complications related to the use of meropenem, including allergic reactions, seizures, or other adverse events 7.
• The patient may also be at risk for complications related to the PICC line, including infection, thrombosis, or other catheter-related complications 5.
• The patient's high BMI and hypertension may also increase the risk of complications, such as wound infections or cardiovascular events 4, 5.