Taku Furukawa, Yugeesh Lankadeva, Ian Baldwin, Pei Chen Connie Ow, Sally Hood, Antoine Schneider, Laurent A Decosterd, Clive N May, Rinaldo Bellomo
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引用次数: 0
Abstract
Introduction: Hemoadsorption can be used as adjunctive therapy for sepsis. However, there is limited evidence regarding its antibiotic removal. In this in vivo preclinical study, we aimed to evaluate the removal of meropenem and piperacillin with the HA380 hemoadsorption cartridge.
Methods: Healthy adult sheep (n = 6) received 2 g of meropenem, and 4 g of piperacillin intravenously for 30 minutes followed by hemoadsorption with a HA380 cartridge at a blood flow rate of 120 mL/min for 4 hours. The sorbent-based removal ratio, clearance, and mass removal were calculated at multiple time points.
Results: The sorbent-based removal ratio of meropenem decreased from 95.4% (SD 1.8) at 10 minutes to less than 20% at 4-hours of hemoadsorption. Its cumulative sorbent-based mass removal was 386.6 mg (SD 78.8) over 4 hours with 65.6 % (SD 7.1) occurring in the first 60 minutes. In contrast, the sorbent-based removal ratio of piperacillin decreased more gradually from 98.4% (SD 0.6) at 10 minutes to 37.4% (SD 7.2) at 4 hours. Its cumulative sorbent-based mass removal was 647.4 mg (SD 191.3) over 4 hours with 63.4% (SD 4.2) occurring in the first 60 minutes. The overall sorbent-based clearance of piperacillin was significantly greater than meropenem (Pgroup < 0.0001).
Conclusion: Hemoadsoprtion with the HA380 cartridge removed meropenem and piperacillin throughout a 4-hour period, with high clearances at the start. Our findings can be used to inform dosing decisions during hemoadsorption in septic patients, there may be the need to consider increasing the doses of these antibiotics by 15-25 % to prevent underdosing.
期刊介绍：
Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.
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