Does the cytokine adsorber CytoSorb® reduce vancomycin exposure in critically ill patients with sepsis or septic shock? a prospective observational study

Scharf, Christina; Weinelt, Ferdinand; Schroeder, Ines; Paal, Michael; Weigand, Michael; Zoller, Michael; Irlbeck, Michael; Kloft, Charlotte; Briegel, Josef und Liebchen, Uwe (23. May 2022): Does the cytokine adsorber CytoSorb® reduce vancomycin exposure in critically ill patients with sepsis or septic shock? a prospective observational study. In: Annals of Intensive Care, Vol. 12

Abstract

Background Hemadsorption of cytokines is used in critically ill patients with sepsis or septic shock. Concerns have been raised that the cytokine adsorber CytoSorb ® unintentionally adsorbs vancomycin. This study aimed to quantify vancomycin elimination by CytoSorb ® .

Methods Critically ill patients with sepsis or septic shock receiving continuous renal replacement therapy and CytoSorb ® treatment during a prospective observational study were included in the analysis. Vancomycin pharmacokinetics was characterized using population pharmacokinetic modeling. Adsorption of vancomycin by the CytoSorb ® was investigated as linear or saturable process. The final model was used to derive dosing recommendations based on stochastic simulations.

Results 20 CytoSorb ® treatments in 7 patients (160 serum samples/24 during CytoSorb ® -treatment, all continuous infusion) were included in the study. A classical one-compartment model, including effluent flow rate of the continuous hemodialysis as linear covariate on clearance, best described the measured concentrations (without CytoSorb ® ). Significant adsorption with a linear decrease during CytoSorb ® treatment was identified (p < 0.0001) and revealed a maximum increase in vancomycin clearance of 291% (initially after CytoSorb ® installation) and a maximum adsorption capacity of 572 mg. For a representative patient of our cohort a reduction of the area under the curve (AUC) by 93 mg/L*24 h during CytoSorb ® treatment was observed. The additional administration of 500 mg vancomycin over 2 h during CytoSorb ® attenuated the effect and revealed a negligible reduction of the AUC by 4 mg/L*24 h.

Conclusion We recommend the infusion of 500 mg vancomycin over 2 h during CytoSorb ® treatment to avoid subtherapeutic concentrations.

• Item Type: Journal article
• Form of publication: Publisher's Version
• Faculties: Medicine > Medical Center of the University of Munich > Clinic for Anaesthesiology; Medicine > Medical Center of the University of Munich > Institute of Laboratory Medicine
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 2110-5820
• Language: English
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892