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Baud FJ, Jullien V, Desnos-Ollivier M, Lamhaut L, Lortholary O. Caspofungin sequestration in a polyacrylonitrile-derived filter: Increasing the dose does not mitigate sequestration. Int J Antimicrob Agents 2023; 62:107007. [PMID: 37839719 DOI: 10.1016/j.ijantimicag.2023.107007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 09/10/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Critically ill patients frequently require continuous renal replacement therapy. Echinocandins are recommended as first-line treatment of candidemia. Preliminary results suggested echinocandin sequestration in a polyacrylonitrile filter. The present study aimed to determine whether increasing the dose might balance sequestration. METHODS An STX filter (Baxter-Gambro) was used. A liquid chromatography-mass spectrometry method was used for dosage of caspofungin. In vitro drug disposition was evaluated by NeckEpur (Neckepur, Versailles, France) technology using a crystalloid medium instead of diluted/reconstituted blood, focusing on the disposition of the unbound fraction of drugs. Two concentrations were assessed. RESULTS At the low dose, the mean measured initial concentration in the central compartment (CC) was 5.1 ± 0.6 mg/L. One hundred percent of the initial amount was eliminated from the CC within the 6-h session. The mean total clearance from the CC was 9.6 ± 2.5 L/h. The mean percentages of elimination resulting from sequestration and diafiltration were 96.0 ± 5.0 and 4.0 ± 5.2%, respectively. At high dose, the mean measured initial concentration in the CC was 13.1 mg/L. One hundred percent of the initial amount was eliminated from the CC within the 6-h session. The mean total clearance from the CC was 9.5 L/h. The mean percentages of elimination resulting from sequestration and filtration were 88.5% and 11.5%, respectively. CONCLUSION Increasing the dose does not mitigate caspofungin sequestration in the STX filter. The results raise caution about the simultaneous use of caspofungin and polyacrylonitrile-derived filters. Intermittent modes of renal replacement therapy might be considered. For sensitive species, fluconazole might be an alternative.
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Affiliation(s)
- Frédéric J Baud
- Département d'Anesthésie-Réanimation Adulte-SAMU de Paris, Hôpital Necker; Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France.
| | - Vincent Jullien
- Université Sorbonne Paris Nord, IAME, INSERM, Paris, France; UF de Pharmacologie, Hôpital Jean Verdier, APHP, Bondy, France
| | | | - Lionel Lamhaut
- Département d'Anesthésie-Réanimation Adulte-SAMU de Paris, Hôpital Necker; Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France
| | - Olivier Lortholary
- Necker Pasteur Centre for Infectious Diseases and Tropical Medicine, IHU Imagine, Necker Enfants Malades, University Hospital, Paris, France; Institut Pasteur, Université Paris Cité, Paris, France
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Le Ven J, Pellan C, Maulet V, Le Monnier A, Baud FJ. Elimination of cefotaxime using polysulfone and polyacrylonitrile-derived filters: An in vitro assessment. Int J Artif Organs 2023; 46:113-119. [PMID: 36583520 DOI: 10.1177/03913988221143803] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Continuous renal replacement therapy (CCRT) efficiently eliminates cefotaxime. To our knowledge, there are no previous in vitro studies dealing with the disposition of cefotaxime. We studied the elimination of cefotaxime by two filters in a model mimicking a session of CRRT using the NeckEpur® technology. The ST150®-polyacrylonitrile filter with the Prismaflex, Baxter-Gambro, and the AV1000®-polysulfone filter with the Multifiltrate Pro, Fresenius, were studied. Continuous filtration used a flowrate of 1 L/h in post-dilution only. Simulated blood flowrate was set at 200 mL/min. Routes of elimination were assessed using the NeckEpur® technology. Cefotaxime concentrations were measured using ultra high-performance liquid chromatography, and tandem mass spectrometry. Two sessions were performed using the ST® filter and three using the AV® filter. Stability of cefotaxime during 6 h was assessed in triplicate with a mean variation of concentrations of 2.4 ± 1.5% at the end of the study. The mean measured initial concentration in the central compartment (CC) for the five sessions was 52.4 mg/L. The mean amount eliminated from the CC at the end of the sessions using the ST150®-polyacrylonitrile and the AV1000®-polysulfone filters were 72% and 73%, respectively. The clearances of cefotaxime from the central compartment (CC) were 1.1 and 1.2 L/h, respectively. The mean sieving coefficient were 0.99 and 0.99, respectively. The mean percentages of the amount eliminated from the CC by filtration/adsorption were 87/13% and 92/8%, respectively. Both adsorption percentages were below 15%. We conclude neither the ST150®-polyacrylonitrile nor the AV1000®-polysulfone filters result in clinically significant adsorption of cefotaxime.
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Affiliation(s)
- Jessica Le Ven
- Clinical Microbiology Department and Therapeutic Drug Monitoring Platform, GH Paris Saint-Joseph, Paris, France
| | - Camille Pellan
- Clinical Microbiology Department and Therapeutic Drug Monitoring Platform, GH Paris Saint-Joseph, Paris, France
| | - Valentin Maulet
- Clinical Microbiology Department and Therapeutic Drug Monitoring Platform, GH Paris Saint-Joseph, Paris, France.,Department of Anesthesiology and Intensive Care Medicine, Adult Intensive Care Unit, Necker Hospital, Paris, France
| | - Alban Le Monnier
- Clinical Microbiology Department, GH Paris Saint-Joseph, Paris, France.,Institut Micalis, UMR 1319 University Paris Saclay, INRAE, AgroParis Tech, Chatenay-Malabry, France
| | - Frédéric J Baud
- Department of Anesthesiology and Intensive Care Medicine, Adult Intensive Care Unit, Necker Hospital, Paris, France.,EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics - Hôpitaux Universitaires Cochin - Broca - Hôtel Dieu, Site Tarnier, Université Paris Descartes, Paris, France
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Baud FJ, Seif V, Houzé P, Raphalen JH, Pilmis B, Carli P, Lamhaut L. Elimination of three doses of gentamicin over three consecutive days using a polyacrylonitrile-derived filter: An in vitro assessment. Int J Artif Organs 2021; 44:641-650. [PMID: 34348515 DOI: 10.1177/03913988211032236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Adsorption of gentamicin in a polyacrylonitrile filter was previously evidenced in a session lasting 6 h using the NeckEpur model. We extended the study over three consecutive days to mimic the 72-h life span of a filter. METHODS Prismaflex® monitor and ST150® filter were used in the continuous diafiltration (CDF) mode at a 2.5 L/h flowrate. The daily session started with a 6-h session of CDF. Thereafter, the 5-L central compartment was changed using a bag free of gentamicin to assess gentamicin release over the following 18 h. Experiments were repeated on Day 2 and stopped at the end of the 6-h session of CDF on Day 3. The experiment was performed in duplicate. RESULTS At a 2.5 L/h diafiltration flowrate, the mean daily clearances of gentamicin were 5.5, 4.0, and 3.3 L/h, respectively. The mean diafiltration and adsorption ratios in the daily elimination of gentamicin were 32/68%, 58/42%, and 88/12%, respectively. During days 1 and 2, the mean amount of gentamicin released from the ST150® filter were 14 and 34 mg, respectively. CONCLUSION The pharmacokinetics of gentamicin over 3 days is strongly altered by adsorption in the same filter with a progressive decrease of elimination by adsorption, suggesting saturation of the filter. One limitation of our study results from the mode of administration using a bolus dose instead of an infusion over 30 min. Adsorption adds a clearance to those of diafiltration. The time-dependency of gentamicin clearance precludes using a constant dosage regimen over the filter's life span.
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Affiliation(s)
- Frédéric J Baud
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France.,EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics - Hôpitaux Universitaires Cochin - Broca - Hôtel Dieu, Site Tarnier, Université Paris Descartes, Paris, France.,Université de Paris - Paris Diderot, Paris, France
| | - Vanessa Seif
- Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Pascal Houzé
- CNRS UMR 8258 - U1022, Faculty of Pharmacy, Unité de Technologies Chimiques et Biologiques pour la Santé, Paris, France
| | - Jean-Herlé Raphalen
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France
| | - Benoît Pilmis
- Molecular Mycology Unit, CNRS UMR 2000, Pasteur Institute, Paris, France
| | - Pierre Carli
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France.,Université de Paris - Paris Descartes, Paris, France
| | - Lionel Lamhaut
- Adult Intensive Care Unit, Department of Anesthesiology - SAMU de Paris, Assistance Publique - Hôpitaux de Paris, University Hospital Necker, Paris, France.,Université de Paris - Paris Descartes, Paris, France
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Is caspofungin efficient to treat invasive candidiasis requiring continuous veno-venous hemofiltration? A case report. Therapie 2020; 76:512-515. [DOI: 10.1016/j.therap.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 01/12/2023]
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Baud FJ, Jullien V, Abarou T, Pilmis B, Raphalen JH, Houzé P, Carli P, Lamhaut L. Elimination of fluconazole during continuous renal replacement therapy. An in vitro assessment. Int J Artif Organs 2020; 44:453-464. [DOI: 10.1177/0391398820976144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Continuous renal replacement therapy (CRRT) efficiently eliminates fluconazole. However, the routes of elimination were not clarified. Adsorption of fluconazole by filters is a pending question. We studied the elimination of fluconazole in a model mimicking a session of CRRT in humans using the NeckEpur® model. Two filters were studied. Methods: The AV1000®-polysulfone filter with the Multifiltrate Pro. Fresenius and the ST150®-polyacrylonitrile filter with the Prismaflex. Baxter-Gambro were studied. Continuous filtration used a flowrate of 2.5 L/h in post-dilution only. Session were made in duplicate. Routes of elimination were assessed using the NeckEpur® model. Results: The mean measured initial fluconazole concentration (mean ± SD) for the four sessions in the central compartment (CC) was 14.9 ± 0.2 mg/L. The amount eliminated from the CC at the end of 6 h-session at a 2.5 L/h filtration flowrate for the AV1000®-polysulfone and the ST150®-polyacrylonitrile filters were 90%–93% and 96%–94%, respectively; the clearances from the central compartment (CC) were 2.5–2.6 and 2.4–2.3 L/h, respectively. The means of the instantaneous sieving coefficient were 0.94%–0.91% and 0.99%–0.91%, respectively. The percentages of the amount eliminated from the CC by filtration/adsorption were 100/0%–95/5% and 100/0%–100/0%, respectively. Conclusion: Neither the ST150®-polyacrylonitrile nor the AV1000®-polysulfone filters result in any significant adsorption of fluconazole.
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Affiliation(s)
- Frédéric J Baud
- Department of Anesthesiology and Intensive Care Medicine, Adult Intensive Care Unit, Necker Hospital, Paris, France
- EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics, Hôpitaux Universitaires Cochin—Broca—Hôtel Dieu, Site Tarnier, Université Paris Descartes, Paris, France
- University Paris Diderot, Paris, France
| | - Vincent Jullien
- Assistance Publique—Hôpitaux de Paris, Groupe Hospitalier Paris Seine-Saint-Denis, Bobigny, France
- Molecular Mycology Unit-CNRS UMR 2000, Pasteur Institute, Paris, France
| | - Tarik Abarou
- Laboratoire de Chimie Analytique, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Benoît Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Paris, France
- Institut Micalis, UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Chatenay-Malabry, France
| | - Jean-Herlé Raphalen
- Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France
| | - Pascal Houzé
- Laboratoire de Biochimie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique—Hôpitaux de Paris, Paris, France
- Unité de Technologies Chimiques et Biologiques Pour la Santé, CNRS UMR8258 – U1022, Faculté de Pharmacie Paris Descartes, Paris, France
- Université Paris Descartes, Paris, France
| | - Pierre Carli
- Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France
- Université Paris Descartes, Paris, France
| | - Lionel Lamhaut
- Department of Anesthesiology and Intensive Care Medicine, SAMU de Paris, Adult Intensive Care Unit, Necker Hospital, Paris, France
- Université Paris Descartes, Paris, France
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Baud FJ, Houzé P, Raphalen JH, Winchenne A, Philippe P, Carli P, Lamhaut L. Diafiltration flowrate is a determinant of the extent of adsorption of amikacin in renal replacement therapy using the ST150®-AN69 filter: An in vitro study. Int J Artif Organs 2020; 43:758-766. [DOI: 10.1177/0391398820911928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: In continuous renal replacement therapy, conduction and convection are controlled allowing prescribing dosage regimen improving survival. In contrast, adsorption is an uncontrolled property altering drug disposition. Whether adsorption depends on flowrates is unknown. We hypothesized an in vitro model may provide information in conditions mimicking continuous renal replacement therapy in humans. Methods: ST150®-AN69 filter and Prismaflex dialyzer, Baxter-Gambro were used. Simulated blood flowrate was set at 200 mL/min. The flowrates in the filtration (continuous filtration), dialysis (continuous dialysis), and diafiltration (continuous diafiltration) were 1500, 2500, and 4000 mL/h, respectively. Routes of elimination were assessed using NeckEpur® analysis. Results: The percentages of the total amount eliminated by continuous filtration, continuous dialysis, and continuous diafiltration were 82%, 86%, and 94%, respectively. Elimination by effluents and adsorption accounted for 42% ± 7% and 58% ± 5%, 57% ± 7% and 43% ± 6%, and 84% ± 6% and 16% ± 6% of amikacin elimination, respectively. There was a linear regression between flowrates and amikacin clearance: Y = 0.6 X ± 1.7 (R2 = 0.9782). Conversely, there was a linear inverse correlation between the magnitude of amikacin adsorption and flowrate: Y = –16.9 X ± 84.1 (R2 = 0.9976). Conclusion: Low flowrates resulted in predominant elimination by adsorption, accounting for 58% of the elimination of amikacin from the central compartment in the continuous filtration mode at 1500 mL/h of flowrate. Thereafter, the greater the flowrate, the lower the adsorption of amikacin in a linear manner. Flowrate is a major determinant of adsorption of amikacin. There was an about 17% decrease in the rate of adsorption per increase in the flowrate of 1 L/min.
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Affiliation(s)
- Frédéric Joseph Baud
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
- Université de Paris, Paris, France
- EA7323, Université de Paris, Paris, France
| | - Pascal Houzé
- Laboratoire de Biochimie, Necker Hospital, Paris, France
- UMR8258 – U1022, Paris, France
| | - Jean-Herlé Raphalen
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
| | - Anaïs Winchenne
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
| | - Pascal Philippe
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
| | - Pierre Carli
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
- Université de Paris, Paris, France
| | - Lionel Lamhaut
- Department of Anesthesiology an Intensive Care Medicine, Adult Intensive Care Unit, SAMU de Paris, Necker Hospital, Paris, France
- Université de Paris, Paris, France
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