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Randomized Controlled Trial
. 2024 Aug;63(8):1167-1176.
doi: 10.1007/s40262-024-01397-w. Epub 2024 Aug 5.

Antibiotics Removal during Continuous Renal Replacement Therapy in Septic Shock Patients: Mixed Modality Versus "Expanded Haemodialysis"

Fiorenza Ferrari  1   2 , Paola Milla  3 , Marco Sartori  1 , Christian Zanza  4   5 , Manfredi Tesauro  6   7 , Yaroslava Longhitano  8   9 , Annalisa De Silvestri  10 , Chiara Abbruzzese  2 , Silvia De Rosa  1   11   12 , Sergio Lassola  11 , Sara Samoni  1   13 , Alessandra Brendolan  1 , Monica Zanella  1 , Vittorio Scaravilli  2   14 , Giacomo Grasselli  2   15 , Silvia Arpicco  3 , Claudio Ronco  1
Affiliations
Randomized Controlled Trial

Antibiotics Removal during Continuous Renal Replacement Therapy in Septic Shock Patients: Mixed Modality Versus "Expanded Haemodialysis"

Fiorenza Ferrari et al. Clin Pharmacokinet. 2024 Aug.

Abstract

Background and objective: Renal replacement therapy (RRT) plays a critical role in antimicrobial removal, particularly for low-molecular-weight drugs with low plasma protein binding, low distribution volume and hydrophilicity. Medium cut-off (MCO) membranes represent a new generation in dialysis technology, enhancing diffusive modality efficacy and increasing the cut-off from 30 to 45 kDa, crucial for middle molecule removal. This monocentric randomized crossover pilot study aimed to evaluate the impact of continuous haemodialysis with MCO membrane (MCO-CVVHD) on the removal of piperacillin, tazobactam and meropenem compared with continuous veno-venous hemodiafiltration with standard high-flux membrane (HFM-CVVHDF).

Methods: Twenty patients were randomized to undergo MCO-CVVHD followed by HFM-CVVHDF or vice versa. Extraction ratio (ER), effluent clearance (Cleff) and treatment efficiency were assessed at various intervals. Antibiotic nadir plasma levels were measured for both treatment days.

Results: HFM-CVVHDF showed greater ER compared with MCO-CVVHD for meropenem (β = - 8.90 (95% CI - 12.9 to - 4.87), p < 0.001) and tazobactam (β = - 8.29 (95% CI - 13.5 to - 3.08), p = 0.002) and Cleff for each antibiotic (meropenem β = - 10,206 (95% CI - 14,787 to - 5787), p = 0.001); tazobactam (β = - 4551 (95% CI - 7781 to - 1322), p = 0.012); piperacillin (β = - 3913 (95% CI - 6388 to - 1437), p = 0.002), even if the carryover effect influenced the Cleff for meropenem and tazobactam. No difference was observed in nadir plasma concentrations or efficiency for any antibiotic. Piperacillin (β = - 38.1 (95% CI - 47.9 to - 28.3), p < 0.001) and tazobactam (β = - 4.45 (95% CI - 6.17 to - 2.72), p < 0.001) showed lower nadir plasma concentrations the second day compared with the first day, regardless the filter type.

Conclusion: MCO demonstrated comparable in vivo removal of piperacillin, tazobactam and meropenem to HFM.

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References

    1. Joannes-Boyau O, Honoré PM, Perez P, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med. 2013;39:1535–46. - DOI - PubMed
    1. Trotman RL, Williamson JC, Shoemaker DM, Salzer WL. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy. Clin Infect Dis. 2005. https://doi.org/10.1086/444500 . - DOI - PubMed
    1. Bugge JF. Pharmacokinetics and drug dosing adjustments during continuous venovenous hemofiltration or hemodiafiltration in critically ill patients. Acta Anaesthesiol Scand. 2001. https://doi.org/10.1034/j.1399-6576.2001.450802.x . - DOI - PubMed
    1. Ferrari F, Sartori M, Milla P. Antibiotic adjustment in continuous renal replacement therapy. In: Critical care nephrology: third edition. 2019. https://doi.org/10.1016/B978-0-323-44942-7.00175-8 .
    1. Pinder M, Bellomo R, Lipman J. Pharmacological principles of antibiotic prescription in the critically III. Anaesth Intensive Care. 2002. https://doi.org/10.1177/0310057x0203000203 . - DOI - PubMed

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