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

• Published in: Annals of intensive care Vol. 12; no. 1; p. 44
• Main Authors: Scharf, Christina, Weinelt, Ferdinand, Schroeder, Ines, Paal, Michael, Weigand, Michael, Zoller, Michael, Irlbeck, Michael, Kloft, Charlotte, Briegel, Josef, Liebchen, Uwe
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 23.05.2022; Springer Nature B.V; SpringerOpen
• Subjects: Adsorption; Anesthesiology; Antibiotics; Critical Care Medicine; Critically ill patients; Cytokines; CytoSorb; Emergency Medicine; Hematology; Intensive; Intensive care; Medicine; Medicine & Public Health; NCT; NCT03985605; Observational studies; Pharmacokinetics; Sepsis; Vancomycin; Sepsis; Vancomycin; CytoSorb; Adsorption; Pharmacokinetics; Critically ill patients
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-022-01017-5

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. Trial registration NCT03985605. Registered 14 June 2019, https://clinicaltrials.gov/ct2/show/NCT03985605