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Antibiotics Removal during Continuous Renal Replacement Therapy in Septic Shock Patients: Mixed Modality Versus "Expanded Haemodialysis".
Ferrari, Fiorenza; Milla, Paola; Sartori, Marco; Zanza, Christian; Tesauro, Manfredi; Longhitano, Yaroslava; De Silvestri, Annalisa; Abbruzzese, Chiara; De Rosa, Silvia; Lassola, Sergio; Samoni, Sara; Brendolan, Alessandra; Zanella, Monica; Scaravilli, Vittorio; Grasselli, Giacomo; Arpicco, Silvia; Ronco, Claudio.
Afiliación
  • Ferrari F; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Azienda ULSS 8 Berica, Vicenza, Italy.
  • Milla P; Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Sartori M; Department of Drug Science and Technology, University of Turin, Turin, Italy.
  • Zanza C; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Azienda ULSS 8 Berica, Vicenza, Italy.
  • Tesauro M; Geriatric Medicine Residency Program, University of Rome "Tor Vergata", 00133, Rome, Italy. christian.zanza@live.it.
  • Longhitano Y; Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA. christian.zanza@live.it.
  • De Silvestri A; Geriatric Medicine Residency Program, University of Rome "Tor Vergata", 00133, Rome, Italy.
  • Abbruzzese C; Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy.
  • De Rosa S; Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA.
  • Lassola S; Department of Emergency Medicine-Emergency Medicine Residency Program, Humanitas University-Research Hospital, 20089, Rozzano, Italy.
  • Samoni S; SSD Biostatistica e Clinical Trial Center, Direzione Scientifica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Brendolan A; Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Zanella M; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Azienda ULSS 8 Berica, Vicenza, Italy.
  • Scaravilli V; Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy.
  • Grasselli G; Centre for Medical Sciences-CISMed, University of Trento, Trento, Italy.
  • Arpicco S; Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy.
  • Ronco C; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Azienda ULSS 8 Berica, Vicenza, Italy.
Clin Pharmacokinet ; 63(8): 1167-1176, 2024 Aug.
Article en En | MEDLINE | ID: mdl-39102092
ABSTRACT
BACKGROUND AND

OBJECTIVE:

Renal replacement therapy (RRT) plays a critical role in antimicrobial removal, particularly for low-molecular-weight drugs with low plasma protein binding, low distribution volume and hydrophilicity. Medium cut-off (MCO) membranes represent a new generation in dialysis technology, enhancing diffusive modality efficacy and increasing the cut-off from 30 to 45 kDa, crucial for middle molecule removal. This monocentric randomized crossover pilot study aimed to evaluate the impact of continuous haemodialysis with MCO membrane (MCO-CVVHD) on the removal of piperacillin, tazobactam and meropenem compared with continuous veno-venous hemodiafiltration with standard high-flux membrane (HFM-CVVHDF).

METHODS:

Twenty patients were randomized to undergo MCO-CVVHD followed by HFM-CVVHDF or vice versa. Extraction ratio (ER), effluent clearance (Cleff) and treatment efficiency were assessed at various intervals. Antibiotic nadir plasma levels were measured for both treatment days.

RESULTS:

HFM-CVVHDF showed greater ER compared with MCO-CVVHD for meropenem (ß = - 8.90 (95% CI - 12.9 to - 4.87), p < 0.001) and tazobactam (ß = - 8.29 (95% CI - 13.5 to - 3.08), p = 0.002) and Cleff for each antibiotic (meropenem ß = - 10,206 (95% CI - 14,787 to - 5787), p = 0.001); tazobactam (ß = - 4551 (95% CI - 7781 to - 1322), p = 0.012); piperacillin (ß = - 3913 (95% CI - 6388 to - 1437), p = 0.002), even if the carryover effect influenced the Cleff for meropenem and tazobactam. No difference was observed in nadir plasma concentrations or efficiency for any antibiotic. Piperacillin (ß = - 38.1 (95% CI - 47.9 to - 28.3), p < 0.001) and tazobactam (ß = - 4.45 (95% CI - 6.17 to - 2.72), p < 0.001) showed lower nadir plasma concentrations the second day compared with the first day, regardless the filter type.

CONCLUSION:

MCO demonstrated comparable in vivo removal of piperacillin, tazobactam and meropenem to HFM.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Séptico / Diálisis Renal / Estudios Cruzados / Meropenem / Terapia de Reemplazo Renal Continuo / Antibacterianos Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Pharmacokinet Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Séptico / Diálisis Renal / Estudios Cruzados / Meropenem / Terapia de Reemplazo Renal Continuo / Antibacterianos Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Pharmacokinet Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Suiza