TY - JOUR A1 - Scharf, Christina A1 - Weinelt, Ferdinand Anton A1 - Schroeder, Ines A1 - Paal, Michael A1 - Weigand, Michael A1 - Zoller, Michael A1 - Irlbeck, Michael A1 - Kloft, Charlotte A1 - Briegel, Josef A1 - Liebchen, Uwe T1 - Does the cytokine adsorber CytoSorb (R) reduce vancomycin exposure in critically ill patients with sepsis or septic shock? BT - a prospective observational study JF - Annals of intensive care N2 - Background: Hemadsorption of cytokines is used in critically ill patients with sepsis or septic shock. Concerns have been raised that the cytokine adsorber CytoSorb (R) unintentionally adsorbs vancomycin. This study aimed to quantify vancomycin elimination by CytoSorb (R) . Methods: Critically ill patients with sepsis or septic shock receiving continuous renal replacement therapy and CytoSorb (R) 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 (R) was investigated as linear or saturable process. The final model was used to derive dosing recommendations based on stochastic simulations. Results: 20 CytoSorb (R) treatments in 7 patients (160 serum samples/24 during CytoSorb (R)-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 (R)). Significant adsorption with a linear decrease during CytoSorb (R) treatment was identified (p <0.0001) and revealed a maximum increase in vancomycin clearance of 291% (initially after CytoSorb (R) 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 (R) treatment was observed. The additional administration of 500 mg vancomycin over 2 h during CytoSorb (R) attenuated the effect and revealed a negligible reduction of the AUC by 4 mg/L*24h. Conclusion: We recommend the infusion of 500 mg vancomycin over 2 h during CytoSorb (R) treatment to avoid subtherapeutic concentrations. KW - Vancomycin KW - Critically ill patients KW - CytoSorb (R) KW - Sepsis; KW - Pharmacokinetics KW - Adsorption Y1 - 2022 U6 - https://doi.org/10.1186/s13613-022-01017-5 SN - 2110-5820 VL - 12 IS - 1 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - Weinelt, Ferdinand Anton A1 - Stegemann, Miriam Songa A1 - Theloe, Anja A1 - Pfäfflin, Frieder A1 - Achterberg, Stephan A1 - Weber, Franz A1 - Dübel, Lucas A1 - Mikolajewska, Agata A1 - Uhrig, Alexander A1 - Kiessling, Peggy A1 - Huisinga, Wilhelm A1 - Michelet, Robin A1 - Hennig, Stefanie A1 - Kloft, Charlotte T1 - Evaluation of a meropenem and piperacillin monitoring program in intensive care unit patients calls for the regular assessment of empirical targets and easy-to-use dosing decision tools JF - Antibiotics : open access journal N2 - The drug concentrations targeted in meropenem and piperacillin/tazobactam therapy also depend on the susceptibility of the pathogen. Yet, the pathogen is often unknown, and antibiotic therapy is guided by empirical targets. To reliably achieve the targeted concentrations, dosing needs to be adjusted for renal function. We aimed to evaluate a meropenem and piperacillin/tazobactam monitoring program in intensive care unit (ICU) patients by assessing (i) the adequacy of locally selected empirical targets, (ii) if dosing is adequately adjusted for renal function and individual target, and (iii) if dosing is adjusted in target attainment (TA) failure. In a prospective, observational clinical trial of drug concentrations, relevant patient characteristics and microbiological data (pathogen, minimum inhibitory concentration (MIC)) for patients receiving meropenem or piperacillin/tazobactam treatment were collected. If the MIC value was available, a target range of 1-5 x MIC was selected for minimum drug concentrations of both drugs. If the MIC value was not available, 8-40 mg/L and 16-80 mg/L were selected as empirical target ranges for meropenem and piperacillin, respectively. A total of 356 meropenem and 216 piperacillin samples were collected from 108 and 96 ICU patients, respectively. The vast majority of observed MIC values was lower than the empirical target (meropenem: 90.0%, piperacillin: 93.9%), suggesting empirical target value reductions. TA was found to be low (meropenem: 35.7%, piperacillin 50.5%) with the lowest TA for severely impaired renal function (meropenem: 13.9%, piperacillin: 29.2%), and observed drug concentrations did not significantly differ between patients with different targets, indicating dosing was not adequately adjusted for renal function or target. Dosing adjustments were rare for both drugs (meropenem: 6.13%, piperacillin: 4.78%) and for meropenem irrespective of TA, revealing that concentration monitoring alone was insufficient to guide dosing adjustment. Empirical targets should regularly be assessed and adjusted based on local susceptibility data. To improve TA, scientific knowledge should be translated into easy-to-use dosing strategies guiding antibiotic dosing. KW - meropenem KW - piperacillin/tazobactam KW - antimicrobial stewardship KW - critically ill KW - antibiotics KW - pharmacokinetic/pharmacodynamic Y1 - 2022 U6 - https://doi.org/10.3390/antibiotics11060758 SN - 2079-6382 VL - 11 IS - 6 PB - MDPI CY - Basel ER -