MO274: Vancomycin Adsorption During In Vitro Model of Hemoperfusion with Mini-Module of HA380 Cartridge

Abstract

Abstract BACKGROUND AND AIMS Septic shock is one of the most frequent causes in Intensive Care Unit (ICU) admission and is related to a very high risk of mortality. About one-third of patients with sepsis develops AKI which contributes to a worsening prognosis. AKI due to sepsis is the result of a dysregulated host immune response to infection, with the production of inflammatory mediators and cytokines that cause haemodynamic alterations, endothelial damage, apoptosis and, finally, immunoparalysis. The new Jafron HA380 cartridge has been specifically designed for use in clinical conditions characterized by cytokine storm such as sepsis. Given the growing application of these devices in cases of septic AKI in ICU, an unsolved problem is whether these polymers adsorb drugs, including antibiotics. In vitro experiments were conducted to determine its adsorption capacity toward Vancomycin antibiotic. METHOD In vitro circulation was performed using a dedicated testing platform Galileo. A customized cartridge was built assembling mini-module components scaled in dimension toward HA380 and filled with 75 g of HA380 beads (25% of the regular size cartridge). Peristaltic pump was set at 250 mL/min. we performed two circulation containing extremely high quantity of Vancomycin (5 g in 500 mL and 10 g in 1000 mL) for 300 minutes. Samples were collected every 20 minutes. Vancomycin concentrations were measured. The adsorption isotherm was represented using the equation: Massadsorbed = RR × Massinjected, where the RR in the Vancomycin removal ratio. RESULTS In vitro circulation confirms the affinity of beads material in binding Vancomycin molecules. The kinetics of vancomycin adsorption shows a rapid decay of the concentration in the first part of the experiments, after which we can observed a plateau (Fig. 1a). A total of 4500 mg of the 5000 mg were adsorbed in the end of the experiment (RR = 94%), of which 90% in the first 40 minutes (RR = 87%); after this period the curve became flat and the adsorption phenomenon negligible (Fig. 1b). In the experiment with 10 000 mg, after 60 minutes of rapid adsorption (RR = 55%), the curve reached a plateau converging to a RR higher than 60% (Fig.). The sorbent beads were able to bind 6100 mg toward 10 000 mg injected. This amount saturated the mini-module binding sites. CONCLUSION The application of HA380 mini-modules allowed to determine the amount of Vancomycin necessary to reach the saturation of the sorbent material. Based on the obtained results, we estimated that the cartridge HA380 could retain more than 24 g of Vancomycin during HP circulation. Further investigation is needed to validate our results and to better understand HA380 performance in clinical practice.