Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, China.
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.
BMC Infect Dis. 2024 Aug 31;24(1):894. doi: 10.1186/s12879-024-09774-3.
Sepsis is a life-threatening organ dysfunction caused by an excessive host response to infection, manifested by elevated levels of inflammatory cytokines. At present, the use of hemoperfusion to remove inflammatory cytokines from the bloodstream has been expanding. Meanwhile, the pharmacokinetics and pharmacodynamics characteristics of antibiotics in critically ill patients may be impacted by hemoperfusion.
The patient was a 69-year-old male with poorly controlled type 2 diabetes. When admitted to the ICU, Multiple Organ Dysfunction Syndrome (MODS) appeared within 48 h, and he was suspected of septic shock due to acute granulocytopenia and significantly increased procalcitonin. Broad-spectrum antibiotics imipenem was administered according to Sepsis 3.0 bundle and hemoperfusion lasting 4 h with a neutron-macroporous resin device (HA-380, Jafron, China) five times was conducted to lower the extremely high value of serum inflammatory factors. Blood samples were collected to measure imipenem plasma concentration to investigate the effect of hemoperfusion quantitatively. This study showed that 4 h of hemoperfusion had a good adsorption ability on inflammatory factors and could remove about 75.2% of imipenem.
This case demonstrated the high adsorption capacity of hemoperfusion on imipenem in critically ill patients. It implies a timely imipenem supplement is required, especially before hemoperfusion.
脓毒症是一种危及生命的器官功能障碍，由宿主对感染的过度反应引起，表现为炎症细胞因子水平升高。目前，使用血液灌流从血液中清除炎症细胞因子的方法已经得到了扩展。同时，重症患者抗生素的药代动力学和药效学特征可能会受到血液灌流的影响。
患者为 69 岁男性，患有未控制的 2 型糖尿病。入住 ICU 后 48 小时内出现多器官功能障碍综合征（MODS），因急性粒细胞减少症和降钙素原显著升高，怀疑为感染性休克。根据 Sepsis 3.0 捆绑治疗方案给予广谱抗生素亚胺培南，并进行了 4 小时的血液灌流，使用了中子大孔树脂装置（HA-380，Jafron，中国）五次，以降低血清炎症因子的极高值。采集血样测量亚胺培南血浆浓度，定量研究血液灌流的效果。本研究表明，4 小时的血液灌流对炎症因子具有良好的吸附能力，可去除约 75.2%的亚胺培南。
本病例表明血液灌流对重症患者亚胺培南具有较高的吸附能力。这意味着需要及时补充亚胺培南，尤其是在血液灌流之前。
