Extracorporeal therapy in the treatment of sepsis: In vitro assessment of the effect of an absorbent cartridge on the circulating bacterial concentration and its interaction with the antibiotic therapy

Abstract

Sepsis is one of the major causes of death worldwide. In its physiopathological process, a broad spectrum of pro and antiinflammatory mediators plays a strategic role, leading to a sepsis induced state of immunoparalysis. The rationale behind the employment of extracorporeal purification techniques as a complement to therapy for sepsis is based on their ability to remove the mediators involved. Until now, attention was focused on the immunomodulation allowed by purification therapies. However, the focus of studies on the application possibilities that these techniques offer as a supplement to antimicrobial therapy and resuscitation of critically ill patients must be extended. In this study, the possible removal by adsorption that the Jafron® HA330 cartridge operates against bacteria (S. aureus) was evaluated in vitro. Subsequently, it was evaluated whether the adsorptive capabilities toward bacteria were maintained by using a cartridge functionalized with Vancomycin and whether the latter maintains its bactericidal activity. This study showed that HA330 reduces the circulating bacterial load, even in the presence of pre-adsorbed Vancomycin. Vancomycin, once adsorbed by the cartridge, does not guarantee its bactericidal activity during the 2-h of hemoperfusion treatment.

Sorbent functionalization with vancomycin enhances bacteria killing in extracorporeal hemoadsorption

“…In the present work, after 60 min and 120 min, we observed a prolongation in the TTP of the blood cultures. This TTP prolongation is reinforced by a significant decrease in the number of CFUs on Blood Agar plates after 120 min (similar results in a previous study of our group with saline instead of blood) 12 . This is essential because this reduction in the mass of bacteria could potentially improve the prognosis of patients with sepsis and septic shock while waiting for the antibiotics to start their effect.…”

“…Resin adsorption is achieved through ionic bonds, van der Waal forces, and hydrophobic bonds 16 . In a previous work, we confirmed how the binding of bacteria to the beads occurs exclusively on their surface and not inside the pores, so functionalizing this surface accentuates this adsorption process 12 …”

“…As can be highlighted from the studies by Godi et al. and de Cal et al., 12,16 this interval is sufficient for the cartridge to adsorb 99.2% ± 0.6% of the vancomycin present in the solution. We were able to adsorb 85% of vancomycin.…”

“…Recently, our group demonstrated the possibility of reducing the circulating bacterial load by adsorption using neutral meso/macropores styrene‐divinylbenzene copolymer beads, functionalized and non‐functionalized with vancomycin in an in vitro model with saline (0.9% NaCl) instead of blood. However, as it is carried out in saline, elements that could interfere with the bacterial and vancomycin adsorption such as the Vroman effect are not considered 12 . The Vroman effect is exhibited by protein adsorption to a surface by blood serum proteins.…”

“…This approach might contribute to antibiotic therapy and resuscitation of critically ill patients while reducing pharmacological toxicity and related complications. We recently demonstrated that HA380 cartridges (Jafron, Zhuhai City, China) adsorb significant amounts of vancomycin when perfused with a vancomycin‐enriched solution 12 …”