In vitro removal of anti-infective agents by a novel cytokine adsorbent system
- 13 December 2018
- journal article
- research article
- Published by SAGE Publications in The International Journal of Artificial Organs
- Vol. 42 (2), 57-64
- https://doi.org/10.1177/0391398818812601
Abstract
The aim of this study is to describe the in vitro adsorption of anti-infective drugs onto an extracorporeal cytokine adsorber. Various anti-infective drugs (β-lactams, quinolones, aminoglycosides, glycopeptides, azole antimycotics) were prepared in normal saline 0.9% and human albumin 5%, and pumped through a cytokine cartridge (CytoSorb®; CytoSorbents Corporation, Monmouth Junction, NJ, USA) at a flow rate of 1.2 L/h for 1.5 h. In addition, meropenem and ciprofloxacin were dissolved in reconstituted blood and run through a CytoSorb cartridge, which was integrated into a continuous renal replacement therapy circuit with a flow rate of 2 L/h for 18 h. Samples from the solution, pre- and post-filter, were quantified by high-performance liquid chromatography with ultraviolet detection and fluorescence polarisation immunoassay. Observed mean clearance of the drugs in normal saline was 1.22 ± 0.07 L/h. In human albumin, clearance was 1.29 ± 0.08 L/h. In reconstituted blood, clearance of meropenem decreased from 5.4 to 1.4 L/h and for ciprofloxacin from 6.3 to 4.3 L/h within the first 1.5 h because of early drug adsorption. Continuous renal replacement therapy clearance measured without CytoSorb was stable at 2 and 1.7 L/h, respectively. Approximately 400 mg of meropenem and 300 mg of ciprofloxacin had been adsorbed by CytoSorb, suggesting that these amounts are the maximum adsorptive capacity for these drugs. In these settings, all tested drugs were adsorbed by the cartridge in relevant amounts. The identified maximum adsorptive capacity and the rapid decline in concentration during the first 1.5 h of CytoSorb use suggest that the administration of an additional dose within the first hours of CytoSorb treatment may be reasonable. In addition, early therapeutic drug monitoring should be considered.Keywords
This publication has 16 references indexed in Scilit:
- Cytokine Reduction in the Setting of an ARDS-Associated Inflammatory Response with Multiple Organ FailureCase Reports in Critical Care, 2016
- First Successful Combination of ECMO with Cytokine Removal Therapy in Cardiogenic Septic Shock: A Case ReportThe International Journal of Artificial Organs, 2015
- Anti-Infective Drugs during Continuous Hemodialysis –Using the Bench to Learn What to do at the BedsideThe International Journal of Artificial Organs, 2015
- Use of a novel hemoadsorption device for cytokine removal as adjuvant therapy in a patient with septic shock with multi-organ dysfunction: A case studyIndian Journal of Critical Care Medicine, 2014
- Newly Designed CRRT Membranes for Sepsis and SIRS—A Pragmatic Approach for Bedside Intensivists Summarizing the More Recent AdvancesAsaio Journal, 2013
- Red blood cell transfusion in the critically ill patientAnnals of Intensive Care, 2011
- Effects of hemoadsorption on cytokine removal and short-term survival in septic ratsCritical Care Medicine, 2008
- Feasibility study of cytokine removal by hemoadsorption in brain-dead humans*Critical Care Medicine, 2008
- Pharmacokinetics and total elimination of meropenem and vancomycin in intensive care unit patients undergoing extended daily dialysis*Critical Care Medicine, 2006
- Dicloxacillin and flucloxacillin: Pharmacokinetics, protein binding and serum bactericidal titers in healthy subjects after oral administrationInfection, 1995