title: In vivo antibiotic removal during coupled plasma filtration adsorption: a retrospective study.
abstract: Coupled plasma filtration adsorption (CPFA) is a blood purification therapy aimed at modulating the host inflammatory response involved in sepsis pathogenesis. One potential drawback of this technique is the unexpected elimination of antibiotics. The aim of this study was to assess the elimination of several antibiotics with CPFA. We performed a retrospective analysis of the serum and ultrafiltrate concentrations of different antibiotics routinely measured during CPFA sessions in five patients experiencing septic shock. The adsorbent extraction ratio (AER) for piperacillin and vancomycin 2 h into the CPFA session were high: 95.4 ± 6.9% and 99.6 ± 0.9%, respectively. These AER decreased significantly by 8 h (at 8 h: 6.3 ± 51.8% and -30.2 ± 25.6%, respectively), suggesting saturation of the resin cartridge. Conversely, the tazobactam AER was low (7.2 ± 15% after 2 h of CPFA). No significant changes in the mean serum concentrations of piperacillin, tazobactam, and vancomycin were observed. Thus, as opposed to tazobactam, we report high adsorption of piperacillin and vancomycin on the CPFA resin but with no reduction in serum concentrations.
authors.affiliation: From the *Department of Anesthesiology and Critical Care Medicine, Pavilion P, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France; †Laboratory of Toxicology and Biochemistry, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Pierre-Bénite, France; and ‡The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Page
authors.forename: Sabine
authors.initials: S
authors.lastname: Cohen
authors.forename: Charles-Eric
authors.initials: CE
authors.lastname: Ber
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.forename: Thomas
authors.initials: T
authors.lastname: Rimmelé
mesh_terms: D000327:Adsorption; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000493:pharmacokinetics*; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents