Lorenzin Anna, de Cal Massimo, Marcello Matteo, Sorbo David, Copelli Sabrina, Ronco Claudio, de Rosa Silvia, Zanella Monica
Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy.
International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.
Blood Purif. 2023;52(2):174-182. doi: 10.1159/000526149. Epub 2022 Sep 12.
Sepsis is a frequent complication in critically ill patients. Patients may require control of the source of infection, removal of pathogens and damaged cells, and organ support. Often, these targets can be achieved through the utilization of extracorporeal therapies including hemoperfusion for the adsorption of cytokines and other circulating mediators. On extracorporeal organ support, patients are generally treated with antibiotic therapy, and vancomycin is one of the most commonly used antibiotics. Because of the aspecific nature of adsorption, antibiotics can be removed from the circulation, leading to altered plasma levels and requiring prescription adjustment. The aim was to define the amount of vancomycin adsorbed by a sorbent cartridge (HA380, Jafron, China) during hemoperfusion and to establish possible strategies to maintain an effective plasma level in critically ill patients undergoing extracorporeal therapies.
In vitro experiments with incremental concentrations of vancomycin in the test solution (500 and 1,000 mL) were carried out in a recirculation circuit until sorbent saturation was observed. A maximum of 10 g of vancomycin were injected and mini-modules containing 25 g of dry resin were utilized.
In different experiments with various concentration of vancomycin, a maximum amount of 244 mg/g of sorbent was adsorbed reaching saturation between 60 and 80 min from the beginning of the experiments. The kinetics of adsorption appears to be governed by a Langmuir-like isotherm with maximal removal speed in the early minutes and a plateau after 60 min.
DISCUSSION/CONCLUSION: HA380 adsorbs significant amounts of vancomycin. Adjusting the achieved results with the experimental mini-module to a full-scale cartridge, a total of 25 g of antibiotic can be removed. This might have affected outcome results in clinical trials. This suggests prescribing administration to critically ill patients requiring hemoperfusion, immediately after or in the inter-session time window. In case of administration during hemoperfusion, adequate adjustment and plasma level monitoring is strongly recommended.
脓毒症是重症患者常见的并发症。患者可能需要控制感染源、清除病原体和受损细胞以及进行器官支持。通常，这些目标可通过体外治疗来实现，包括血液灌流以吸附细胞因子和其他循环介质。在体外器官支持治疗中，患者一般会接受抗生素治疗，万古霉素是最常用的抗生素之一。由于吸附作用的非特异性，抗生素可从循环中被清除，导致血浆水平改变，需要调整处方。本研究旨在确定血液灌流期间一种吸附柱（HA380，珠海健帆生物科技股份有限公司，中国）吸附万古霉素的量，并制定可能的策略以维持接受体外治疗的重症患者有效的血浆水平。
在循环回路中，对测试溶液（500和1000 mL）中逐渐增加浓度的万古霉素进行体外实验，直至观察到吸附柱饱和。最多注入10 g万古霉素，并使用含有25 g干树脂的微型模块。
在不同浓度万古霉素的不同实验中，吸附柱的最大吸附量为244 mg/g，从实验开始60至80分钟达到饱和。吸附动力学似乎受类似朗缪尔等温线的控制，在最初几分钟内去除速度最快，60分钟后达到平稳状态。
讨论/结论：HA380能吸附大量万古霉素。将实验微型模块的结果换算为完整规格的吸附柱，总共可去除25 g抗生素。这可能影响了临床试验的结果。这表明对于需要血液灌流的重症患者，应在血液灌流后或灌流间隙立即给药。若在血液灌流期间给药，强烈建议进行适当调整并监测血浆水平。
