Abstract
The extracorporeal elimination of a pathogen or damage-associated molecular pattern via blood purification techniques is increasingly being used in patients with septic shock and other clinical conditions characterized by a life-threatening inflammatory response. The removal of these substances can be accomoplished by means of ultrafiltration or hemoadsorption. Independently from the blood putification technique used, they could also affect the clearance of antibacterial and antifungal agents with a potentially significant clinical impact. In our review, we describe the basic principles of ultrafiltration and hemoadsorption, the available devices for this latter and the existing experimental and clinical studies; the final paragraph is dedicated to practical considerations that can help clinicians to consider the clearance of antibiotics and antifungals attributable to these techniques to minimize the risk of a iatrogenic underdosage.
Highlights
Even in the absence of randomized clinical trials (RCTs) fulfilling the Evidence-Based Medicine (EBM) criteria or recommendations provided by the recently issued guidelines of the Surviving Sepsis Campaign (SSC) [1,2], the extracorporeal removal of pathogen or damage-associated molecular patterns (PAMPs and DAMPs, respectively) via techniques of blood purification (BP) is increasingly used to treat patients with septic shock or other clinical conditions characterized by an excessive inflammatory response [3]
To address the issue of the possible removal of antibacterial and antifungal agents by means of HA we reviewed the available literature published in the last 10 years on PubMed using the key words “hemoadsorption” and “antibiotic removal”
HA can be performed either in a stand-alone mode or with Continuous Renal Replacement Therapy (CRRT) for patients with acute kidney injury (AKI) or with Extra Corporeal Membrane Oxygenation (ECMO); in the former case, it appears that the combination of the two techniques can exert additional effects on the removal of therapeutic agents
Summary
Even in the absence of randomized clinical trials (RCTs) fulfilling the Evidence-Based Medicine (EBM) criteria or recommendations provided by the recently issued guidelines of the Surviving Sepsis Campaign (SSC) [1,2], the extracorporeal removal of pathogen or damage-associated molecular patterns (PAMPs and DAMPs, respectively) via techniques of blood purification (BP) is increasingly used to treat patients with septic shock or other clinical conditions characterized by an excessive inflammatory response [3] This non-EBM founded popularity can be ascribed primarily to the failure of other approaches aiming at the neutralization of these substances by means of specific antibodies or inhibitors; the results of many RCTs performed to evaluate the effect of this approach did not confirm the promising results obtained in experimental and pre-clinical studies.
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