Adsorption of various antimicrobial agents to endotoxin removal polymyxin-B immobilized fiber (Toraymyxin®)

Shimokawa, Ken‐ichi; Takakuwa, Ryotaro; Taya, Kumiko; Wada, Yuko; Yamazaki, Noriko; Morimoto, Masahiro; Hirata, Kiyotaka; Masuno, Tomohiko; Ishii, Fumiyoshi

doi:10.1016/j.colsurfb.2011.09.046

Cited by 22 publications

(13 citation statements)

References 15 publications

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“…71 Similarly, an in vitro study assessing the effects of polymyxin B immobilized fiber column hemoperfusion on nine antibiotics reported adsorption of linezolid, suggesting a necessity for the monitoring of blood antimicrobial concentrations during polymyxin B immobilized fiber column hemoperfusion. 72,73 A larger literature is present on hemofiltration, suggesting an increased antibiotic clearance with these devices. [74][75][76]…”

Section: Future Directionsmentioning

confidence: 99%

Blood Purification and Mortality in Sepsis and Septic Shock

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality. We performed a systematic review with meta-analysis of randomized trials to assess whether extracorporeal blood purification reduces mortality in this setting. Methods Electronic databases were searched for pertinent studies up to January 2019. We included randomized controlled trials on the use of hemoperfusion, hemofiltration without a renal replacement purpose, and plasmapheresis as a blood purification technique in comparison to conventional therapy in adult patients with sepsis and septic shock. The primary outcome was mortality at the longest follow-up available. We calculated relative risks and 95% CIs. The grading of recommendations assessment, development and evaluation methodology for the certainty of evidence was used. Results Thirty-seven trials with 2,499 patients were included in the meta-analysis. Hemoperfusion was associated with lower mortality compared to conventional therapy (relative risk = 0.88 [95% CI, 0.78 to 0.98], P = 0.02, very low certainty evidence). Low risk of bias trials on polymyxin B immobilized filter hemoperfusion showed no mortality difference versus control (relative risk = 1.14 [95% CI, 0.96 to 1.36], P = 0.12, moderate certainty evidence), while recent trials found an increased mortality (relative risk = 1.22 [95% CI, 1.03 to 1.45], P = 0.02, low certainty evidence); trials performed in the United States and Europe had no significant difference in mortality (relative risk = 1.13 [95% CI, 0.96 to 1.34], P = 0.15), while trials performed in Asia had a positive treatment effect (relative risk = 0.57 [95% CI, 0.47 to 0.69], P < 0.001). Hemofiltration (relative risk = 0.79 [95% CI, 0.63 to 1.00], P = 0.05, very low certainty evidence) and plasmapheresis (relative risk = 0.63 [95% CI, 0.42 to 0.96], P = 0.03, very low certainty evidence) were associated with a lower mortality. Conclusions Very low-quality randomized evidence demonstrates that the use of hemoperfusion, hemofiltration, or plasmapheresis may reduce mortality in sepsis or septic shock. Existing evidence of moderate quality and certainty does not provide any support for a difference in mortality using polymyxin B hemoperfusion. Further high-quality randomized trials are needed before systematic implementation of these therapies in clinical practice.

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Section: Future Directionsmentioning

confidence: 99%

Blood Purification and Mortality in Sepsis and Septic Shock

et al. 2019

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“…Furthermore, there was note of decreased platelet and leukocyte counts, which tended to be more pronounced in the longer-duration groups. Also, it has been demonstrated that antibiotics are adsorbed to some degree onto the PMX cartridge [25,26]. Presumably such adsorption could be exacerbated by longer hemoperfusion times, and may potentially affect efficacy of antibiotic therapy.…”

Section: Refining the Treatment Strategy: Treatment Durationmentioning

confidence: 99%

New Trends in Polymyxin B Hemoperfusion: From 2006 to 2013

Cruz¹

2014

Blood Purif

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Endotoxin, one of the principal components on the outer membrane of Gram-negative bacteria, is considered a key and early component in the pathogenesis of sepsis. Polymyxin B bound to polystyrene fibers (PMX) is a medical device capable of removing circulating endotoxin by adsorption. The most comprehensive analysis to date of clinical experience with this device remains a meta-analysis of 28 studies between 1998 and 2006. This showed that PMX hemoperfusion was associated with improved blood pressure and a reduction in dopamine dose, improved PaO₂/FiO₂ ratio and lower mortality. Since this meta-analysis, over 50 additional studies on PMX have been published. The majority are observational, with small sample sizes. Notable among the newer studies is the increasing interest in the use of PMX therapy in interstitial pneumonias and idiopathic pulmonary fibrosis, as well as in longer treatment duration and earlier initiation of PMX therapy in an attempt to further improve clinical outcomes. These observational data highlight important aspects of PMX therapy worthy of more rigorous investigation in future studies.

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“…Тем не менее, в испытаниях in vitro, проводимых в среде с разными антимикробными агентами, такими как пиперациллин, ципрофлоксацин и линезолид, была выявлена способность сорбента к элиминации в разной степени всех исследуемых веществ. При этом снижение концентрации ципрофлоксацина и пиперациллина после перфузии через иммобилизованный полимиксин B составило всего 4-6%, в то время как для линезолида эта величина оказалась равной 20-25% [18]. Установлена также зависимость эффективности адсорбции линезолида в соответствии с длительностью сеансов гемоперфузии.…”

Section: Introductionunclassified

Effect of Extracorporal Hemosorption on Elimination of Antibacterial Drugs in Sepsis

Якубцевич¹,

Белявский²

2021

Journal GrSMU

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Background. Sepsis and septic shock make a significant proportion of the causes of death in intensive care units. Hemosorption in combination with standard sepsis therapy reduces mortality by an average of 5-7% and significantly lowers the need for vasopressor support. Purpose of the study. Our aim is to investigate the data available about the effect of hemosorption on the dynamics of antibiotic levels in the blood plasma of patients. Material and methods. The results of more than 20 studies of the efficacy of various hemosorbents in the treatment of sepsis were analyzed. Results. Data on the significant effect of CytoSorb and Toraymyxin B sorbents on the pharmacokinetics of a number of antibiotics have been obtained. There are no data on the Belarusian sorbents Proteasosorb and LPS-hemo. Conclusions. The degree of elimination of antibacterial drugs during hemosorption depends on the specific characteristics of each sorbent. All potential adverse effects need to be carefully studied to maximize the use of hemosorption in the treatment of sepsis.

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Adsorption of various antimicrobial agents to endotoxin removal polymyxin-B immobilized fiber (Toraymyxin®)

Cited by 22 publications

References 15 publications

Blood Purification and Mortality in Sepsis and Septic Shock

Blood Purification and Mortality in Sepsis and Septic Shock

New Trends in Polymyxin B Hemoperfusion: From 2006 to 2013

Effect of Extracorporal Hemosorption on Elimination of Antibacterial Drugs in Sepsis

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