17 The Polyethersulfone Membrane “Express” Has a Higher Piperacillin/Tazobactam Clearance Independant of the Dialysis Dose

Abstract

THE POLYETHERSULFONE MEMBRANE “EXPRESS” HAS A HIGHER PIPERACILLIN/TAZOBACTAM CLEARANCE INDEPENDANT OF THE DIALYSIS DOSE. Milen Amde, Charbel Salem, Joseph Groszek, Michael Connor, Seth Bauer, William Fissell; Cleveland Clinic Foundation, Cleveland, Ohio. In the intensive care setting, infection remains the leading cause of death in AKI. The goal of our study is to assess the impact of membrane types and continuous veno-venous hemodialysis (CVVHD) dose on the clearance and serum levels of piperacillin-tazobactam (piptazo). Using high-performance liquid chromatography (HPLC), we measured the serum and dialysate concentrations of pip-tazo. We then calculated the total clearance and area under the curve (AUC) of the drug in 28 anuric ICU patients who were on CVVHD for uninterrupted 24 hours and received 3.375 g Pip-Tazo q 8 hours (n=21) or q 12 hours (n=7). The 15 patients on the polyacrylnitrile M100 had a total pip clearance of 50.3±17.56 ml/min compared to 64.28±25.77 ml/min in the 13 patients on the polyethersulfone membrane Express. We used regression analysis to examine the association between total clearance, trough level, AUC and the variables; filter type, CVVHD dose and dosing interval (the latter was included in the trough level and AUC analysis only). We showed a trend towards lower total clearance with the M100 membrane compared to the Express membrane (coefficient of -11.62, p=0.0203). There was a trend towards lower AUC with higher CVVHD dose (coefficient of -83.2, p=0.0281) and less frequent dosing (-3.8 coefficient for q12 vs q8, p=0.0322) independent of membrane type. In conclusion, the membrane type and the CVVHD dose should be considered when deciding on antibiotics dosage in the critically ill patient. Larger studies are needed to study the impact of CRRT on antibiotics target pharmacokinetic levels and whether more frequent dosing of antibiotics would affect outcomes.