Selig Daniel J, Reed Tyler, Chung Kevin K, Kress Adrian T, Stewart Ian J, DeLuca Jesse P
Department of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Blood Purif. 2023;52(1):25-31. doi: 10.1159/000524457. Epub 2022 May 6.
The Seraph® 100 Microbind® Affinity Blood Filter (Seraph 100) is a hemoperfusion device that can remove pathogens from central circulation. However, the effect of Seraph 100 on achieving pharmacodynamic (PD) targets is not well described. We sought to determine the impact of Seraph 100 on ability to achieve PD targets for commonly used antibiotics.
Estimates of Seraph 100 antibiotic clearance were obtained via literature. For vancomycin and gentamicin, published pharmacokinetic models were used to explore the effect of Seraph 100 on ability to achieve probability of target attainment (PTA). For meropenem and imipenem, the reported effect of continuous kidney replacement therapy (CKRT) on achieving PTA was used to extrapolate decisions for Seraph 100.
Seraph 100 antibiotic clearance is likely less than 0.5 L/h for most antibiotics. Theoretical Seraph 100 clearance up to 0.5 L/h and 2 L/h had a negligible effect on vancomycin PTA in virtual patients with creatinine clearance (CrCl) = 14 mL/min and CrCl >14 mL/min, respectively. Theoretical Seraph 100 clearance up to 0.5 L/h and 2 L/h had a negligible effect on gentamicin PTA in virtual patients with CrCl = 120 mL/min and CrCl <60 mL/min, respectively. CKRT intensity resulting in antibiotic clearance up to 2 L/h generally does not require dose increases for meropenem or imipenem. As Seraph 100 is prescribed intermittently and likely contributes far less to antibiotic clearance, dose increases would also not be required.
Seraph 100 clearance of vancomycin, gentamicin, meropenem, and imipenem is likely clinically insignificant. There is insufficient evidence to recommend increased doses. For aminoglycosides, we recommend extended interval dosing and initiating Seraph 100 at least 30 min to 1 h after completion of infusion to avoid the possibility of interference with maximum concentrations.
Seraph® 100 Microbind® 亲和性血液滤过器（Seraph 100）是一种能从体循环中清除病原体的血液灌流装置。然而，Seraph 100对实现药效学（PD）目标的影响尚未得到充分描述。我们试图确定Seraph 100对常用抗生素实现PD目标能力的影响。
通过文献获取Seraph 100对抗生素清除率的估计值。对于万古霉素和庆大霉素，使用已发表的药代动力学模型来探讨Seraph 100对实现目标达成概率（PTA）能力的影响。对于美罗培南和亚胺培南，利用持续肾脏替代疗法（CKRT）对实现PTA的报道效果来推断Seraph 100的相关情况。
对于大多数抗生素，Seraph 100的抗生素清除率可能低于0.5 L/h。理论上，Seraph 100清除率分别达到0.5 L/h和2 L/h时，对肌酐清除率（CrCl）=14 mL/min和CrCl>14 mL/min的虚拟患者的万古霉素PTA影响可忽略不计。理论上，Seraph 100清除率分别达到0.5 L/h和2 L/h时，对CrCl = 120 mL/min和CrCl<60 mL/min的虚拟患者的庆大霉素PTA影响可忽略不计。导致抗生素清除率高达2 L/h的CKRT强度通常不需要增加美罗培南或亚胺培南的剂量。由于Seraph 100是间歇性使用的，且可能对抗生素清除的贡献要小得多，因此也不需要增加剂量。
Seraph 100对万古霉素、庆大霉素、美罗培南和亚胺培南的清除在临床上可能无显著意义。没有足够的证据推荐增加剂量。对于氨基糖苷类药物，我们建议延长给药间隔，并在输注完成后至少30分钟至1小时开始使用Seraph 100，以避免干扰最高血药浓度。
