The Effects of Hemoadsorption on the Kinetics of Antibacterial and Antifungal Agents

The Role of the Intravenous IgA and IgM-Enriched Immunoglobulin Preparation in the Treatment of Sepsis and Septic Shock

Polyclonal Intravenous Immunoglobulins (IvIg) are often administered to critically ill patients more as an act of faith than on the basis of relevant clinical studies. This particularly applies to the treatment of sepsis and septic shock because the current guidelines recommend against their use despite many investigations that have demonstrated their beneficial effects in different subsets of patients. The biology, mechanisms of action, and clinical experience related to the administration of IvIg are reviewed, which aim to give a more in-depth understanding of their properties in order to clarify their possible indications in sepsis and septic shock patients.

Antimicrobial Exposure in Critically Ill Patients with Sepsis-Associated Multi-Organ Dysfunction Requiring Extracorporeal Organ Support: A Narrative Review

Sepsis is a leading cause of disability and mortality worldwide. The pathophysiology of sepsis relies on the maladaptive host response to pathogens that fosters unbalanced organ crosstalk and induces multi-organ dysfunction, whose severity was directly associated with mortality. In septic patients, etiologic interventions aiming to reduce the pathogen load via appropriate antimicrobial therapy and the effective control of the source infection were demonstrated to improve clinical outcomes. Nonetheless, extracorporeal organ support represents a complementary intervention that may play a role in mitigating life-threatening complications caused by sepsis-associated multi-organ dysfunction. In this setting, an increasing amount of research raised concerns about the risk of suboptimal antimicrobial exposure in critically ill patients with sepsis, which may be worsened by the concomitant delivery of extracorporeal organ support. Accordingly, several strategies have been implemented to overcome this issue. In this narrative review, we discussed the pharmacokinetic features of antimicrobials and mechanisms that may favor drug removal during renal replacement therapy, coupled plasma filtration and absorption, therapeutic plasma exchange, hemoperfusion, extracorporeal CO₂ removal and extracorporeal membrane oxygenation. We also provided an overview of evidence-based strategies that may help the physician to safely prescribe effective antimicrobial doses in critically ill patients with sepsis-associated multi-organ dysfunction who receive extracorporeal organ support.

Reduction of Ultrafiltration Membrane Fouling by the Pretreatment Removal of Emerging Pollutants: A Review

Ultrafiltration (UF) processes exhibit high removal efficiencies for suspended solids and organic macromolecules, while UF membrane fouling is the biggest obstacle affecting the wide application of UF technology. To solve this problem, various pretreatment measures, including coagulation, adsorption, and advanced oxidation, for application prior to UF processes have been proposed and applied in actual water treatment processes. Previously, researchers mainly focused on the contribution of natural macromolecular pollutants to UF membrane fouling, while the mechanisms of the influence of emerging pollutants (EPs) in UF processes (such as antibiotics, microplastics, antibiotic resistance genes, etc.) on membrane fouling still need to be determined. This review introduces the removal efficiency and separation mechanism for EPs for pretreatments combined with UF membrane separation technology and evaluates the degree of membrane fouling based on the UF membrane's materials/pores and the structural characteristics of the cake layer. This paper shows that the current membrane separation process should be actively developed with the aim of overcoming specific problems in order to meet the technical requirements for the efficient separation of EPs.