在连续性肾脏替代治疗（CKRT）后设置中，CytoSorb®血液吸附对重症患者美罗培南和哌拉西林暴露量的影响：一项单中心回顾性数据分析

Impact of hemoadsorption with CytoSorb® on meropenem and piperacillin exposure in critically ill patients in a post-CKRT setup: a single-center, retrospective data analysis.

作者信息

Asgarpur Golschan, Weber Franz, Kiessling Peggy, Akbari Nilufar, Stroben Fabian, Kleikamp Bernadette, Kloft Charlotte, Treskatsch Sascha, Angermair Stefan

机构信息

Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.

Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Kelchstr. 31, 12169, Berlin, Germany.

出版信息

Intensive Care Med Exp. 2025 Jan 18;13(1):7. doi: 10.1186/s40635-025-00716-0.

DOI:10.1186/s40635-025-00716-0

PMID:39826040

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11741966/

Abstract

PURPOSE

CytoSorb® (CS) adsorbent is a hemoadsorption filter for extracorporeal blood purification often integrated into continuous kidney replacement therapy (CKRT). It is primarily used in critically ill patients with sepsis and related conditions, including cytokine storms and systemic inflammatory responses. Up to now, there is no evidence nor recommendation for the use of CS filters in sepsis (22). There is limited clinical data on the effect of CS on the plasma concentrations of beta-lactams. We aimed to evaluate the statistical and clinical impact of CS in a post-filter CKRT-CS setting on the plasma concentrations of the antibiotics meropenem and piperacillin in critically ill patients.

METHODS

Patients admitted to the intensive care unit (ICU) who received a prolonged infusion of piperacillin or meropenem with CS-combined CKRT were included in this retrospective analysis. TDM (therapeutic drug monitoring) plasma blood samples were collected at three different points. The differences in antibiotic concentrations between Pre, Intra, and Post were statistically compared to evaluate the total and isolated contributions of CKRT and CS to antibiotic removal. CS, CKRT and combined clearance (CL) values were calculated. The hypothesis was that the CS filter would have no clinically relevant impact on antibiotic levels.

RESULTS

207 TDM samples were taken from 24 critically ill patients requiring beta-lactam antibiotics. Among these, 129 were meropenem samples, and 78 were piperacillin samples. A decrease in both antibiotic levels was observed between Pre and Intra, and Pre and Post, and the median relative difference between was >15% (meropenem: Pre-Intra 34.8%, Pre-Post 35.8%; piperacillin: Pre-Intra 41.1%, Pre-Post 34.7%), indicating a statistically and clinically significant effect of CKRT on both antibiotic exposures. No significant difference was observed between Intra and Post indicating no clinically relevant drug removal via the CS filter. Changes in CL attributed to CS were minimal, with combined CL differing by ≤8.60% compared to CKRT clearance.

CONCLUSION

The application of CS does not appear to significantly affect plasma concentrations of meropenem and piperacillin in critically ill patients.

摘要

目的

CytoSorb®（CS）吸附剂是一种用于体外血液净化的血液吸附滤器，常集成于连续性肾脏替代治疗（CKRT）中。它主要用于患有脓毒症及相关病症（包括细胞因子风暴和全身炎症反应）的危重症患者。到目前为止，尚无证据表明在脓毒症中使用CS滤器有效，也没有相关推荐（22）。关于CS对β-内酰胺类药物血浆浓度影响的临床数据有限。我们旨在评估在滤器后CKRT-CS环境中CS对危重症患者美罗培南和哌拉西林这两种抗生素血浆浓度的统计学及临床影响。

方法

纳入入住重症监护病房（ICU）且接受哌拉西林或美罗培南与CS联合CKRT长期输注的患者进行这项回顾性分析。在三个不同时间点采集治疗药物监测（TDM）血浆血样。对Pre、Intra和Post之间抗生素浓度的差异进行统计学比较，以评估CKRT和CS对抗生素清除的总体及单独贡献。计算CS、CKRT和联合清除率（CL）值。假设是CS滤器对抗生素水平无临床相关影响。

结果

从24例需要β-内酰胺类抗生素的危重症患者中采集了207份TDM样本。其中，129份是美罗培南样本，78份是哌拉西林样本。观察到Pre与Intra之间以及Pre与Post之间两种抗生素水平均下降，且两者之间的中位相对差异>15%（美罗培南：Pre-Intra为34.8%，Pre-Post为35.8%；哌拉西林：Pre-Intra为41.1%，Pre-Post为34.7%），表明CKRT对两种抗生素暴露均有统计学及临床显著影响（P<0.001）。Intra与Post之间未观察到显著差异，表明通过CS滤器未发生临床相关的药物清除。归因于CS的CL变化极小，联合CL与CKRT清除率相比差异≤8.60%。