Evaluation of plasma levels of meropenem in septic patients during extracorporeal blood purification

2021 ◽  
Vol 20 (4) ◽  
pp. 81-94
Author(s):  
Artem V. Marukhov ◽  
Elena V. Murzina ◽  
Mikhail V. Zakharov ◽  
Genrikh A. Sofronov ◽  
Lyudmila V. Buryakova ◽  
...  
Keyword(s):  
Septic Shock ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Selective Adsorption ◽  
Plasma Concentrations ◽  
Blood Purification ◽  
Continuous Hemodiafiltration ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Extracorporeal Support

The relevance. Meropenem is a broad-spectrum carbapenem antibiotic widely used to treat patients with sepsis / septic shock. Critically ill patients are usually supported with one of the forms extracorporeal blood purification. However, data on the effect of various extracorporeal support techniques on the pharmacokinetics and pharmacodynamics of meropenem are insufficient or contradictory. Aim: To evaluate the effectiveness of meropenem dosage regimens in the treatment of septic patients during extracorporeal blood purification. Materials and methods. Plasma concentrations of meropenem were monitored in three critically ill patients with sepsis or septic shock. Patients were treated using various extracorporeal support techniques. Meropenem was used as empirical antibacterial mono- or complex therapy (1 g every 8 or 12 hours). Meropenem concentrations in plasma were determined by validated assay methods on Acquity ultraefficient liquid chromatography (UPLC) H-Class system. Results. It is shown that the meropenem plasma concentration in critically ill patients changes significantly. It was found that the standard meropenem dosing regimens in patients with sepsis / septic shock during continuous hemodiafiltration do not ensure the achievement of the PK/PD target of 100% TMIC for sensitive strains (MIC2 mg/L) and for intermediate resistance pathogens (2MIC8 mg/L). Continuous hemofiltration and selective adsorption of lipopolysaccharide have a less pronounced effect on the clearance of meropenem. Conclusion. To increase the effectiveness of antibacterial therapy, it is necessary to conduct research aimed at developing protocols for dosing antibacterial drugs for the treatment of sepsis during extracorporeal blood purification.

scholarly journals Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: COMMENTARY

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005242021
Author(s):  
Marlies Ostermann ◽  
Jay L. Koyner
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Purification ◽  
Extracorporeal Blood ◽  
Early Access ◽  
Extracorporeal Blood Purification ◽  
Multi Organ Failure

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0006632020 and the CON: 10.34067/KID.0007382020

scholarly journals Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: CON

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0007382020
Author(s):  
Kianoush B. Kashani ◽  
Lui G. Forni
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Purification ◽  
Extracorporeal Blood ◽  
Early Access ◽  
Extracorporeal Blood Purification ◽  
Multi Organ Failure

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0006632020 and the COMMENTARY 10.34067/KID.0005242021

scholarly journals Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: PRO

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006632020
Author(s):  
Kevin K. Chung ◽  
Stephen W. Olson
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Purification ◽  
Extracorporeal Blood ◽  
Early Access ◽  
Extracorporeal Blood Purification ◽  
Multi Organ Failure

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the CON: 10.34067/KID.0007382020 and the COMMENTARY 10.34067/KID.0005242021

Heparin-based blood purification attenuates organ injury in baboons with S. pneumoniae pneumonia

2021 ◽  
Author(s):  
Lingye Chen ◽  
Bryan D Kraft ◽  
Victor L Roggli ◽  
Zachary R Healy ◽  
Christopher W Woods ◽  
...  
Keyword(s):  
Septic Shock ◽  
Pneumococcal Pneumonia ◽  
Kidney Injury ◽  
Blood Purification ◽  
Dose Finding ◽  
Organ Injury ◽  
Inflammasome Activation ◽  
Post Inoculation ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification

Background: Bacterial pneumonia is a major cause of morbidity and mortality worldwide despite the use of antibiotics, and novel therapies are urgently needed. Building on previous work, we aimed to 1) develop a baboon model of severe pneumococcal pneumonia and sepsis with organ dysfunction; and 2) test the safety and efficacy of a novel extracorporeal blood filter to remove pro-inflammatory molecules and improve organ function. Methods: After a dose-finding pilot study, twelve animals were inoculated with S. pneumoniae (5x109 CFU), given ceftriaxone at 24 hours post-inoculation, and randomized to extracorporeal blood purification using a filter coated with surface-immobilized heparin sulfate (n=6) or sham treatment (n=6) for 4 hours at 30 hours post-inoculation. For safety analysis, four uninfected animals also underwent purification. At 48 hours, necropsy was performed. Results: Inoculated animals developed severe pneumonia and septic shock. Compared with sham animals, septic animals treated with purification displayed significantly less kidney injury, metabolic acidosis, hypoglycemia, and shock (P<0.05). Purification blocked the rise in peripheral blood S. pneumoniae DNA, attenuated BAL CCL4, CCL2, and IL-18 levels, and reduced renal oxidative injury and classical NLRP3-inflammasome activation. Purification was safe in both uninfected and infected animals and produced no adverse effects. Conclusions: We demonstrate that heparin-based blood purification significantly attenuates levels of circulating S. pneumoniae DNA and BAL cytokines, and is renal-protective in baboons with severe pneumococcal pneumonia and septic shock. Purification was associated with less severe acute kidney injury, metabolic derangements, and shock. These results support future clinical studies in critically ill septic patients.

Double extracorporeal blood purification in refractory pediatric septic shock

2019 ◽  
Vol 29 (9) ◽  
pp. 966-967
Author(s):  
Emanuele Rossetti ◽  
Isabella Guzzo ◽  
Zaccaria Ricci ◽  
Roberto Bianchi ◽  
Sergio Picardo
Keyword(s):  
Septic Shock ◽  
Blood Purification ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification

scholarly journals Kinetics of Plasma Cytokines During and After Two Different Modalities of Extracorporeal Blood Purification in Critically Ill COVID-19 Patients

2020 ◽  
Author(s):  
Daniela Ponce ◽  
Welder Zamoner ◽  
Luis Eduardo Magalhães ◽  
Paula Gabriela Souza de Oliveira ◽  
Patricia Polla ◽  
...  
Keyword(s):  
Critically Ill ◽  
Removal Rate ◽  
Kidney Injury ◽  
Blood Purification ◽  
Prognostic Scores ◽  
Removal Rates ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Intermittent Haemodialysis ◽  
Plasma Cytokines

Abstract Cytokine storm syndrome (CSS) has been documented in coronavirus disease 2019 (COVID-19) since the first reports of this disease. In the absence of vaccines or direct therapy for COVID-19, extracorporeal blood treatment (EBT) could represent an option for the removal of cytokines and may be beneficial to improve the clinical outcome of critically ill patients. Intermittent haemodialysis (IHD), using high flux (HF) or high cut-off membranes, and continuous renal replacement therapy (CRRT) could be used for blood purification in COVID-19 patients with CSS. To the best of our knowledge, cytokine kinetics during and after different types of EBT on COVID-19 patients have never been studied. In this study, we describe cytokine variation and removal during and after IHD and CRRT in COVID-19 patients with acute kidney injury (AKI). Methods: Patients with COVID-19-related AKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria and admitted at Intensive Care Unit (ICU) were studied. Blood samples were collected at the start and end of both IHD using HF membranes (10 patients) and continuous venovenous haemodiafiltration (CVVHDF: 10 patients) in two sessions for measuring 13 different plasma interleukins and calculating the cytokine removal rate. Results: We evaluated cytokine removal in patients with COVID-19-related AKI undergoing either prolonged IHD (10 patients) or CRRT (CVVHDF: 10 patients). There was no difference between the IHD and CVVHDF groups regarding mechanical ventilation, vasoactive drug use, age or prognostic scores. Patients treated by CRRT presented higher levels of IL-2 and IL-8 than patients treated by prolonged IHD at the start of dialysis. Cytokine removal ranged from 9–78%. Patients treated by CRRT presented higher cytokine removal rates than those treated by prolonged IHD for IL-2, IL-6 IL-8, IP-10 and TNF. The removal rates of IL-4, IL-10, IL-1β, IL-17A, IFN, MCP-1 and free active TGF-B1 were similar in the two groups. After one session of CVVHDF (24 h) the IL-2 and IL-1β levels did not vary significantly, whereas IL-4, IL-6, IL-8, IL-10, IL-17A, TNF, IFN, IP-10, MCP-1, IL-12p70 and free active TGF-B1 decreased by 33.8–76%, and this decrease was maintained over the next 24 h. In the prolonged IHD groups, IL-2, IL-6, TNF, IP-10 and IL-1β levels did not decrease significantly whereas IL-4, IL-8, IL-10, IL-17A, IFN, MCP-1, IL-12p70 and free active TGF-B1 decreased by 21.8–72%. However, all cytokine levels returned to their initial values after 24 h, despite their removal. Conclusions: Cytokine removal is lower using prolonged IHD with HF membranes than by using CVVHDF, and IHD allows a transient and selective decrease in cytokines that can be correlated with mortality during CSS-related COVID-19.

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