Bottari Gabriella, Goffredo Bianca Maria, Marano Marco, Maccarrone Cristina, Simeoli Raffaele, Bianco Giuseppe, Vallesi Leonardo, Beetham Joseph Charles Charlie, Mazzeo Anna Teresa, Cappoli Andrea, Cairoli Sara, Labbadia Raffaella, Cecchetti Corrado, Bernaschi Paola, Corsetti Tiziana, Morabito Santo, Taccone Fabio Silvio, Guzzo Isabella
Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children's Hospital, IRCSS, 00165 Rome, Italy.
Antibiotics (Basel). 2023 Aug 31;12(9):1395. doi: 10.3390/antibiotics12091395.
Extracorporeal therapies (ET) are increasingly used in pediatric settings as adjuvant therapeutic strategies for overwhelming inflammatory conditions. Although these treatments seem to be effective for removing inflammatory mediators, their influence on antimicrobials pharmacokinetic should not be neglected. A prospective observational study of children admitted to the pediatric intensive care unit (PICU) with a diagnosis of sepsis/septic shock. All critically ill children received hemoadsorption treatment with CytoSorb (CS) in combination with CKRT. Therapeutic drug monitoring has been performed on 10 critically ill children, testing four antimicrobial molecules: meropenem, ceftazidime, amikacin and levofloxacin. In order to evaluate the total and isolated CKRT and CS contributions to antibiotic removal, blood samples at each circuit point (post-hemofilter, post-CS and in the effluent line) were performed. Therefore, the clearance and mass Removal (MR) of the hemofilter and CS were calculated. Our preliminary report describes a different impact of CS on these target drugs removal: CS clearance was low for amikacine (6-12%), moderate for ceftazidime (43%) and moderate to high for levofloxacine (52-72%). Higher MR and clearance were observed with CKRT compared to CS. To the best of our knowledge, this is the first report regarding pharmacokinetic dynamics in critically ill children treated with CKRT and CS for septic shock.
体外治疗（ET）在儿科环境中越来越多地被用作治疗严重炎症性疾病的辅助治疗策略。尽管这些治疗似乎对清除炎症介质有效，但其对抗菌药物药代动力学的影响不容忽视。一项对诊断为脓毒症/脓毒性休克的儿科重症监护病房（PICU）患儿的前瞻性观察研究。所有重症患儿均接受了细胞吸附柱（CS）联合连续性肾脏替代治疗（CKRT）的血液吸附治疗。对10名重症患儿进行了治疗药物监测，检测了四种抗菌分子：美罗培南、头孢他啶、阿米卡星和左氧氟沙星。为了评估CKRT和CS对抗生素清除的总体和单独贡献，在每个循环点（血液滤过后、CS后和流出管线）采集血样。因此，计算了血液滤过器和CS的清除率和质量清除量（MR）。我们的初步报告描述了CS对这些目标药物清除的不同影响：阿米卡星的CS清除率较低（6-12%），头孢他啶的清除率中等（43%），左氧氟沙星的清除率中等至高（52-72%）。与CS相比，CKRT观察到更高的MR和清除率。据我们所知，这是第一份关于用CKRT和CS治疗脓毒性休克的重症患儿药代动力学的报告。
