International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy.
Nephrology and Dialysis Unit, Carlos Van Buren Hospital, Valparaíso, Chile.
Artif Organs. 2024 May;48(5):543-549. doi: 10.1111/aor.14704. Epub 2023 Dec 29.
The level of bacteremia in patients with sepsis and septic shock is a predictor of complications and mortality, regardless of the type of bacteria. Devices for bacteria, endotoxin and cytokines removal by adsorption have been recently developed. Thus, extracorporeal blood purification therapies have been proposed as adjunctive therapy in sepsis in combination with drugs. Some potentially useful drugs, however, are precluded due to their organ or metabolic toxicity. The present study represents a preliminary report on the in vitro effect of a sorbent device (minimodule with HA380 beads, Jafron medical, Zhuhai, China) in which the particles have been functionalized with vancomycin on the surface. The impact of the surface-modified beads on circulating bacteria (Staphylococcus aureus) has been tested in a simulated in vitro circulation.
In vitro experiments were carried out with 800 mL of blood enriched with S. aureus species. Blood was circulated in the vancomycin-functionalized and non-functionalized mini-module cartridges in hemoadsorption setup (300 mL each) and the bactericidal effect was assessed. Also, 200 mL of blood was used as a control.
A significant increase in the time to positivity of blood cultures was observed after 60 min and also after 120 min of therapy with the mini-module functionalized with vancomycin as opposed to the non-functionalized cartridge.
These results suggest a possible way of treating sepsis by using drug- or antibiotic-functionalized cartridges without worrying about pharmacological toxicity. The prolongation of the time to bacterial culture positivity to S. aureus after a passage through a column packed with beads functionalized with vancomycin represents a proof of concept.
脓毒症和感染性休克患者的菌血症水平是并发症和死亡率的预测因素，而与细菌类型无关。最近已经开发出用于通过吸附去除细菌、内毒素和细胞因子的设备。因此，已提出体外血液净化疗法作为脓毒症的辅助治疗方法，与药物联合使用。然而，由于器官或代谢毒性，一些潜在有用的药物被排除在外。本研究代表了一种吸附剂装置（载有 HA380 珠粒的 miniModule，中国珠海捷创医疗科技有限公司）的体外效应的初步报告，其中珠粒的表面已用万古霉素功能化。在模拟体外循环中，测试了表面修饰珠粒对循环细菌（金黄色葡萄球菌）的影响。
用富含金黄色葡萄球菌的 800 毫升血液进行体外实验。血液在万古霉素功能化和非功能化的 miniModule 筒中循环，在血液吸附装置中（各 300 毫升），并评估杀菌效果。还使用 200 毫升血液作为对照。
与非功能化筒相比，用万古霉素功能化的 miniModule 治疗 60 分钟和 120 分钟后，血液培养物的阳性时间明显延长。
这些结果表明，通过使用药物或抗生素功能化的筒，而不必担心药理毒性，可能有一种治疗脓毒症的方法。金黄色葡萄球菌通过载有万古霉素珠粒的柱后，细菌培养阳性时间延长，这代表了一个概念验证。
