In Vivo Antibiotic Removal During Coupled Plasma Filtration Adsorption

Page, M.; Cohen, Sabine; Ber, Charles-Éric; Allaouchiche, Bernard; Kellum, John A.; Rimmelé, Thomas

doi:10.1097/mat.0000000000000009

Cited by 10 publications

(6 citation statements)

References 34 publications

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“…Also common to all techniques is the important issue of drug removal. Antimicrobials, in particular, are of utmost importance [ 70 – 72 ]. In septic patients, antibiotics are the only proven therapy.…”

Section: Adverse Events (The Pitfalls)mentioning

confidence: 99%

Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

et al. 2018

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Sepsis is one of the leading causes of morbidity and mortality worldwide. It is characterized by a dysregulated immune response to infections that results in life-threatening organ dysfunction and even death. Bacterial cell wall components (endotoxin or lipopolysaccharide), known as pathogen-associated molecular patterns (PAMPs), as well as damage-associated molecular patterns (DAMPs) released by host injured cells, are well-recognized triggers resulting in the elevation of both pro-inflammatory and anti-inflammatory cytokines. Understanding this complex pathophysiology has led to the development of therapeutic strategies aimed at restoring a balanced immune response by eliminating/deactivating these inflammatory mediators. Different extracorporeal techniques have been studied in recent years in the hope of maximizing the effect of renal replacement therapy in modulating the exaggerated host inflammatory response, including the use of high volume hemofiltration (HVHF), high cut-off (HCO) membranes, adsorption alone, and coupled plasma filtration adsorption (CPFA). These strategies are not widely utilized in practice, depending on resources and local expertise. The literature examining their use in septic patients is growing, but the evidence to support their use at this stage is considered of low level. Our aim is to provide a comprehensive overview of the technical aspects, clinical applications, and associated side effects of these techniques.

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Section: Adverse Events (The Pitfalls)mentioning

confidence: 99%

Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

et al. 2018

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“…CPFA not only removes substances harmful to the body, but also removes beneficial substances. Piperacillin, tazobactam, and vancomycin, administered during CPFA, using the appropriate dosing regimens, achieved acceptable serum concentrations, despite adsorption on the resin cartridge [ 35 ]. However, a potential disadvantage of this technique is that it may accidentally eliminate other kinds of antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Coupled plasma filtration adsorption for the treatment of sepsis or septic shock: a systematic review and meta-analysis

Guo

Wang

et al. 2022

BMC Infect Dis

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Background The effect of coupled plasma filtration adsorption (CPFA) for the treatment of sepsis or septic shock is controversial. A systematic review and meta-analysis was performed to evaluate the impact of CPFA on all-cause mortality in patients with sepsis or septic shock. Methods We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) and cohort studies from inception to the 1st of May 2022. We included studies involving patients (˃ 14 years) with sepsis or septic shock. All authors reported our primary outcome of all-cause mortality (hospital mortality, 28-day mortality or 30-day mortality). Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI). Results Six studies including 537 patients were included. The primary outcome of this meta-analysis showed that the all-cause mortality was about 54.2% (119/243 in the CPFA group and 172/294 in the control group). There was no statistically significant difference in the all-cause mortality between two groups (odds ratio [OR] = 0.75; 95% CI 0.53 to 1.06; P = 0.11; Chi2 = 14.04; I2 = 64%). Conclusions The treatment of CPFA failed to decrease all-cause mortality of sepsis or septic shock patients. Further large-scale randomized controlled trials (RCTs) evaluating the ability of this therapy to improve clinical outcomes are still required to confirm these results.

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“…Firstly, CPFA is a blood puri cation therapy aimed at modulating the host in ammatory response involved in sepsis pathogenesis. One potential drawback of this technique is the unexpected elimination of antibiotics [35]. Any delay in receiving appropriate antibiotic therapy in severe sepsis or septic shock patients is associated with excess mortality [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Coupled plasma filtration adsorption for the treatment of sepsis or septic shock ： a systematic review and meta-analysis

Guo

Wang

et al. 2022

Preprint

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Background: The effect of coupled plasma filtration adsorption(CPFA) for the treatment of sepsis or septic shock is controversial. A systematic review and meta-analysis was performed to evaluate the impact of CPFA on all-cause mortality in patients with sepsis or septic shock.Methods: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials(RCTs) and cohort studies from inception to the 1st of May 2022. We included studies involving patients (˃14 years) with sepsis or septic shock. All authors reported our primary outcome of all-cause mortality(hospital mortality, 28-day mortality or 30-day mortality). Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI).Results: Six studies including 537 patients were included. The primary outcome of this meta-analysis showed that the all-cause mortality was about 54.2% (119/243 in the CPFA group and 172/294 in the control group). There was no statistically significant difference in the all-cause mortality between two groups(odds ratio [OR]=0.75;95% CI, 0.53 to 1.06; P=0.11;Chi2=14.04; I2=64%).Conclusions: The treatment of CPFA failed to decrease all-cause mortality of sepsis or septic shock patients. Further large-scale randomized controlled trials (RCTs) evaluating the ability of this therapy to improve clinical outcomes are still required to confirm these results.

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In Vivo Antibiotic Removal During Coupled Plasma Filtration Adsorption

Cited by 10 publications

References 34 publications

Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

Coupled plasma filtration adsorption for the treatment of sepsis or septic shock: a systematic review and meta-analysis

Coupled plasma filtration adsorption for the treatment of sepsis or septic shock ： a systematic review and meta-analysis

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