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Does the cytokine adsorber CytoSorb® reduce vancomycin exposure in critically ill patients with sepsis or septic shock? a prospective observational study
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2022-05-23 , DOI: 10.1186/s13613-022-01017-5
Christina Scharf 1 , Ferdinand Weinelt 2, 3 , Ines Schroeder 1 , Michael Paal 4 , Michael Weigand 4 , Michael Zoller 1 , Michael Irlbeck 1 , Charlotte Kloft 2 , Josef Briegel 1 , Uwe Liebchen 1, 2
Affiliation  

Background

Hemadsorption of cytokines is used in critically ill patients with sepsis or septic shock. Concerns have been raised that the cytokine adsorber CytoSorb® unintentionally adsorbs vancomycin. This study aimed to quantify vancomycin elimination by CytoSorb®.

Methods

Critically ill patients with sepsis or septic shock receiving continuous renal replacement therapy and CytoSorb® treatment during a prospective observational study were included in the analysis. Vancomycin pharmacokinetics was characterized using population pharmacokinetic modeling. Adsorption of vancomycin by the CytoSorb® was investigated as linear or saturable process. The final model was used to derive dosing recommendations based on stochastic simulations.

Results

20 CytoSorb® treatments in 7 patients (160 serum samples/24 during CytoSorb®-treatment, all continuous infusion) were included in the study. A classical one-compartment model, including effluent flow rate of the continuous hemodialysis as linear covariate on clearance, best described the measured concentrations (without CytoSorb®). Significant adsorption with a linear decrease during CytoSorb® treatment was identified (p < 0.0001) and revealed a maximum increase in vancomycin clearance of 291% (initially after CytoSorb® installation) and a maximum adsorption capacity of 572 mg. For a representative patient of our cohort a reduction of the area under the curve (AUC) by 93 mg/L*24 h during CytoSorb® treatment was observed. The additional administration of 500 mg vancomycin over 2 h during CytoSorb® attenuated the effect and revealed a negligible reduction of the AUC by 4 mg/L*24 h.

Conclusion

We recommend the infusion of 500 mg vancomycin over 2 h during CytoSorb® treatment to avoid subtherapeutic concentrations.

Trial registration NCT03985605. Registered 14 June 2019, https://clinicaltrials.gov/ct2/show/NCT03985605



中文翻译:

细胞因子吸附剂 CytoSorb® 是否会降低脓毒症或感染性休克重症患者的万古霉素暴露量?一项前瞻性观察研究

背景

细胞因子的血液吸附用于脓毒症或脓毒性休克的重症患者。有人担心细胞因子吸附剂 CytoSorb ®会无意中吸附万古霉素。本研究旨在量化 CytoSorb ®对万古霉素的消除作用。

方法

在一项前瞻性观察研究中接受连续肾脏替代治疗和 CytoSorb ®治疗的败血症或感染性休克重症患者被纳入分析。使用群体药代动力学模型表征万古霉素药代动力学。CytoSorb® 对万古霉素的吸附作为线性或饱和过程进行了研究。最终模型用于根据随机模拟得出剂量建议。

结果

7 名患者的20 次 CytoSorb ®治疗(160 份血清样本/24 在 CytoSorb ®治疗期间,所有持续输注)被纳入研究。经典的单室模型,包括连续血液透析的流出物流速作为清除率的线性协变量,最好地描述了测量的浓度(没有 CytoSorb ®)。发现在 CytoSorb ®处理期间具有线性下降的显着吸附(p < 0.0001)并显示万古霉素清除率的最大增加为 291%(最初在 CytoSorb ®安装后)和 572 mg 的最大吸附容量。对于我们队列的代表性患者,CytoSorb 期间曲线下面积 (AUC) 减少了 93 mg/L*24 h®治疗进行了观察。在 CytoSorb ®期间在 2 小时内额外给予 500 mg 万古霉素减弱了效果,并显示 AUC 减少了 4 mg/L*24 小时,可以忽略不计。

结论

我们建议在 CytoSorb ®治疗期间输注 500 mg 万古霉素超过 2 小时,以避免低于治疗浓度。

试用注册NCT03985605。2019 年 6 月 14 日注册,https://clinicaltrials.gov/ct2/show/NCT03985605

更新日期:2022-05-24
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