Baud Frédéric J, Houzé Pascal, Raphalen Jean-Herlé, Philippe Pascal, Lamhaut Lionel
Département d'Anesthésie et de Réanimation, Adult Intensive Care Unit, Necker Hospital, 75015 Paris, France.
EA7323, Université de Paris, 75006 Paris, France.
Antibiotics (Basel). 2023 Mar 21;12(3):620. doi: 10.3390/antibiotics12030620.
Sequestration of vancomycin in ST filters used in continuous renal therapy is a pending question. Direct vancomycin-ST interaction was assessed using the in vitro NeckEpur technology.
ST150 filter and Prismaflex dialyzer, Baxter-Gambro, were used. Two modes were assessed in duplicate: (i) continuous diafiltration (CDF): 4 L/h, (ii) continuous dialysis (CD): 2.5 L/h post-filtration.
The mean initial vancomycin concentration in the central compartment (CC) was 51.4 +/- 5.0 mg/L. The mean percentage eliminated from the CC over 6 h was 91 +/- 4%. The mean clearances from the CC by CDF and CD were 2.8 and 1.9 L/h, respectively. The mean clearances assessed using cumulative effluents were 4.4 and 2.2 L/h, respectively. The mean percentages of the initial dose eliminated in the effluents from the CC by CDF and CD were 114 and 108% with no detectable sequestration of vancomycin in both modes of elimination.
Significant sequestration adds a clearance to that provided by CDF and CD. The study provides multiple evidence from the CC, the filter, and the effluents of the lack of an increase in total clearance in comparison with the flow rates without significant sequestration in the ST filter comparing cumulative effluents to the initial dose in the CC.
There is no evidence ST filters directly sequestrate vancomycin.
在连续性肾脏治疗中使用的ST滤器对万古霉素的截留是一个悬而未决的问题。使用体外NeckEpur技术评估了万古霉素与ST的直接相互作用。
使用百特-金宝公司生产的ST150滤器和Prismaflex透析器。以一式两份的方式评估两种模式：（i）连续性透析滤过（CDF）：4L/h，（ii）连续性透析（CD）：滤过后2.5L/h。
中央腔室（CC）中万古霉素的平均初始浓度为51.4±5.0mg/L。6小时内从CC中清除的平均百分比为91±4%。CDF和CD从CC的平均清除率分别为2.8L/h和1.9L/h。使用累积流出液评估的平均清除率分别为4.4L/h和2.2L/h。CDF和CD从CC流出液中清除的初始剂量的平均百分比分别为114%和108%，在两种清除模式下均未检测到万古霉素的截留。
显著的截留增加了CDF和CD所提供的清除率。该研究从CC、滤器和流出液中提供了多个证据，表明与ST滤器中无显著截留时的流速相比，总清除率没有增加，将累积流出液与CC中的初始剂量进行比较。
没有证据表明ST滤器直接截留万古霉素。
