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Case Report Volume 14 Issue 2
Infection timeline guided by pharmacodynamics based on pharmacokinetics and inflammatory biomarkers during antibiotic therapy in burn patient – case report
Silvia RCJ Santos, Frederico Ribeiro Pires, Mauro Jorge Santos, Aline Sandre Gomides Abad, Gabriela Aparecida Ferreira, Thiago Câmara de Oliveira, Maria Severina dos Santos, Nilo José Coelho Duarte, Paschoalina Romano, Persio de Almeida Rezende Ebner, Nairo Massakaku Sumita, Debora Cristina Saches Pinto, Edvaldo Vieira de Campos, Elson Mendes da Silva Junior, João Manoel da Silva Jr, David de Souza Gomez
Received: March 28, 2026 | Published: April 27, 2026
Citation: Santos SRCJ, Pires FR, Santos MJ, et al. Infection timeline guided by pharmacodynamics based on pharmacokinetics and inflammatory biomarkers during antibiotic therapy in burn patient – case report. Pharm Pharmacol Int J. 2026;14(2):31-37. DOI: 10.15406/ppij.2026.14.00491
Abstract
Introduction: Infection is the most common complication and cause of death in patients suffering burn injuries, once these patients are susceptible to infection and burn sepsis. It is well known that pharmacokinetics is altered by changes related to renal function in ICU extensive burn patients. In general antibiotic (ATB) de-escalation in Gram-negative infections is routinely used to prevent resistance during prolonged ICU stays for burn patients. Consequently, cultures and ATB serum monitoring ensures optimization of serum levels to achieve the therapeutic goal with eradication of susceptible strains. Objective: Antibiotic therapy based on infection and resistance was guided by therapeutic serum levels and MIC data for treatment selection against Gram-positive and Gram-negative nosocomial bacteria. Pharmacodynamics based on pharmacokinetic changes (PK/PD) was applied. Pharmacokinetics data related to ATBs prescribed was investigated. In addition, to support ATB therapy, inflammatory biomarkers NLR and c-RP were monitored daily to predict and prevent mortality in ICU. Methods: A case report involved a 31-year-old male (160 kg, 171 cm) with severe burns (25% TBSA), multiple injuries, and morbid obesity following an engine explosion at work. ICU admission to the Burn Center started with medical history and injury details documented. Immediate care involved resuscitation, debridement, and management of respiratory and renal issues. Septic shock diagnosis used early microbiological tests and inflammatory biomarkers monitoring. Blood and site-specific cultures were taken before starting antibiotics, which were adjusted dose based on results monitored weekly related to pharmacodynamics based on pharmacokinetic changes tied to renal function. Initially, the recommended ATB protocol recommended in hospital infections was prescribed as a combined therapy, vancomycin against Gram-positive bacteria and piperacillin/tazobactam against Gram-negative bacteria. Daily NLR and c-RP measured ICU mortality risk. Results: On ICU-day 3, the patient’s condition deteriorated, leading to broad-spectrum antibiotics after cultures were obtained. Vancomycin and piperacillin/tazobactam were started; cultures identified Staphylococcus epidermidis (vancomycin/susceptible) and Proteus mirabilis (meropenem/susceptible). Consequently piperacillin/tazobactam was stopped, and meropenem, vancomycin, plus sodium colistinemethate against resistant Acinetobacter baumannii were given for 30 days, dosed by renal function and monitored with TDM and MIC data. A second shock occurred on day 21 with Klebsiella pneumoniae (meropenem/susceptible), so vancomycin and meropenem continued. On day 41, Pseudomonas aeruginosa (resistant to meropenem/amikacin, ciprofloxacin/susceptible) was isolated, and ciprofloxacin was prescribed. Cultures became negative on day 51; the patient was discharged from ICU on day 55 and hospital on day 60. Conclusion: Antibiotic therapy was based on infections and resistance. ATBs doses were adjusted by TDM and target attainment including MIC data guiding treatment selection. PK-changes ensured therapeutic drug levels based on PK/PD targets recommended for prescribed antibiotics. Superiority of the NLR over c-RP in decision-making was demonstrated, as an early biomarker of death in the ICU.
Keywords: ICU major burn sepsis, immunosuppression-prolonged stay, inflammatory biomarker NLR in decision making, antibiotic related to dose adjusted by TDM, PK/PD target attainment
©2026 Santos, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.