Walter Reed Army Institute of Research, Bethesda, Maryland, USA.
Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.
Blood Purif. 2024;53(5):379-385. doi: 10.1159/000531951. Epub 2024 Jan 13.
Novel hemoperfusion systems are emerging for the treatment of sepsis. These devices can directly remove pathogens, pathogen-associated molecular patterns, cytokines, and other inflammatory markers from circulation. However, significant safety concerns such as potential antibiotic clearance need to be addressed prior to these devices being used in large clinical studies.
Prospective, observational study of 34 participants undergoing treatment with the Seraph 100® Microbind Affinity Blood Filter (Seraph 100) device at 6 participating sites in the USA. Patients were included for analysis if they had a record of receiving an antibiotic concurrent with Seraph 100 treatment. Patients were excluded if there was missing information for blood flow rate. Blood samples were drawn pre- and post-filter at 1 h and 4 h after treatment initiation. These average pre- and post-filter time-concentration observations were then used to estimate antibiotic clearance in L/h (CLSeraph) due to the Seraph 100 device.
Of the 34 participants in the study, 17 met inclusion and exclusion criteria for the antibiotic analysis. Data were obtained for 7 antibiotics (azithromycin, cefazolin, cefepime, ceftriaxone, linezolid, piperacillin, and vancomycin) and one beta-lactamase inhibitor. Mean CLSeraph for the antibiotics investigated ranged from -0.57 to 0.47 L/h. No antibiotic had a CLSeraph statistically significant from 0.
DISCUSSION/CONCLUSION: The Seraph 100 did not significantly clear any measured antibiotic in clinical samples. These data give further evidence to suggest that these therapies may be safely administered to critically ill patients and will not impact concentrations of administered antibiotics.
新型血液灌流系统正被应用于脓毒症的治疗。这些设备可直接从血液中清除病原体、病原体相关分子模式、细胞因子和其他炎症标志物。然而,在这些设备被用于大型临床研究之前,需要解决抗生素清除等重大安全问题。
在 6 家美国参与机构对 34 名接受 Seraph 100® Microbind Affinity Blood Filter(Seraph 100)治疗的患者进行前瞻性、观察性研究。如果患者在接受 Seraph 100 治疗的同时有抗生素记录,则将其纳入分析。如果缺少血流率的信息,则将其排除。在治疗开始后 1 h 和 4 h 时分别在过滤前和过滤后抽取血液样本。使用这些平均过滤前后的时间浓度观察值来估计由于 Seraph 100 设备导致的抗生素清除率(CLSeraph)。
在这项研究的 34 名参与者中,有 17 名符合抗生素分析的纳入和排除标准。共获得 7 种抗生素(阿奇霉素、头孢唑林、头孢吡肟、头孢曲松、利奈唑胺、哌拉西林和万古霉素)和一种β-内酰胺酶抑制剂的数据。所研究抗生素的平均 CLSeraph 范围从 -0.57 到 0.47 L/h。没有一种抗生素的 CLSeraph 值与 0 有统计学意义。
讨论/结论:Seraph 100 未显著清除临床样本中的任何被测抗生素。这些数据进一步证明,这些疗法可安全地用于危重症患者,且不会影响所给予抗生素的浓度。