Elimination of glycopeptide antibiotics by cytokine hemoadsorption in patients with septic shock: A study of three cases

Sepsis and septic shock are characterized by a release of cytokines into the circulation. These mediators contribute to the detrimental hemodynamic and metabolic effects in the early phase of septic shock. Recently, a new polystyrene-based hemoadsorption device was introduced into clinical practice (CytoSorb®). The adsorber binds a variety of molecules including cytokines and removes them from the circulation. Studies in septic patients have shown an improved clinical course following hemoadsorption but no increased survival. We hypothesize that not only cytokines but also antibiotics may be removed which potentially may negate any beneficial effect of the adsorber. To test this hypothesis, we performed polystyrene-based hemoadsorption in three patients in septic shock and analysed glycopeptide elimination by measuring serum levels pre- and post-adsorber. We administered both teicoplanin and vancomycin via a 60-min infusion and vancomycin via continuous infusion, additionally. When applied as 60 min infusion, vancomycin and teicoplanin were removed immediately by the adsorber. However, the adsorptive capacity of the device was saturable. Serum levels of vancomycin, but not teicoplanin, decreased to subtherapeutic levels. With continuous infusion of vancomycin, removal was less and serum levels remained in the therapeutic range. In conclusion, we show effective glycopeptide adsorption using a polystyrene-based hemoadsorber in septic patients. The dose of these antibiotics should be adjusted appropriately and early therapeutic drug monitoring is highly recommended.

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Acute Medicine & Surgery ◽

10.1002/ams2.659 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Moritoki Egi ◽

Hiroshi Ogura ◽

Tomoaki Yatabe ◽

Kazuaki Atagi ◽

Shigeaki Inoue ◽

...

Keyword(s):

Septic Shock ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Sepsis And Septic Shock

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Plasma interleukin-6 levels correlate with survival in patients with bacterial sepsis and septic shock

Interventional Medicine and Applied Science ◽

10.1556/1646.2020.00006 ◽

2021 ◽

Vol 11 (4) ◽

pp. 224-230

Author(s):

Monica Chavez Vivas ◽

Hector Fabio Villamarin Guerrero ◽

Antonio Jose Tascon ◽

Augusto Valderrama-Aguirre

Keyword(s):

Septic Shock ◽

Cox Regression ◽

Serum Levels ◽

Significant Decline ◽

Bacterial Sepsis ◽

Inflammatory Biomarker ◽

Statistical Program ◽

Sepsis And Septic Shock ◽

Time Of Admission ◽

Admission Variables

AbstractIn this study, IL-6 levels were assessed as inflammatory biomarker of bacterial sepsis in patients hospitalized at the ICU of the hospital of Colombia.Materials and methodsProspective study on 62 patients diagnosed with sepsis and septic shock. An ELISA assay was used to test serum levels of IL-6 at admission and 48 h after admission. Variables were analyzed by χ2 test (alfa <0.05). Multivariable Cox regression was used to determine the survival with the statistical program SPSS v23.00.ResultsPatient's median age was 53 years old and 59.7% were male. Lung was the most common primary site of infection (43.5%), and hypertension comorbidity with higher prevalence (40%). Infection by Gram negative bacteria were significantly more frequent among patients than Gram positive (P = 0.037). Overall, survival analysis showed that 10 (16.1%) patients died with a survival median of 7.00 +4.874 (2–3) days. In patients with sepsis we detected a significant decline in the average of IL-6 serum levels after 48 h of admission [7.50 (SD: 7.00–68.00) pg/mL vs. 68.00 [SD: 7.00–300.00] pg/mL (P = 0.000). Only 25% of patients with septic shock who presented high levels of IL-6 at the time of admission and at 48 h had a survival up to 15 days (P = 0.005).ConclusionWe found significant differences between the plasma levels of IL-6 during the first 48 h after admission to the ICU among patients with sepsis and septic shock. Patients with sepsis had a significant decline in IL-6 levels, whereas in patients who developed septic shock, levels of this cytokine remained high and have a lower survival compared to those who maintained low levels of IL-6.

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Use of Gentamicin for Sepsis and Septic Shock in Anaesthesia-Intensive Care Unit: A Clinical Practice Evaluation

Turkish Journal of Anaesthesiology and Reanimation ◽

10.5152/tjar.2019.57255 ◽

2020 ◽

Vol 48 (5) ◽

pp. 399-405

Author(s):

Cyril Pernod ◽

◽

Antoine Lamblin ◽

Andrei Cividjian ◽

Patrick Gerome ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Intensive Care ◽

Clinical Practice ◽

Sepsis And Septic Shock

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Erratum:The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020（J-SSCG 2020）[Journal of the Japanese Society of Intensive Care Medicine Vol. 28（2020）, Supplement pp.S1-S411]

Journal of the Japanese Society of Intensive Care Medicine ◽

10.3918/jsicm.28s_1 ◽

2021 ◽

Vol 28 (Supplement) ◽

pp. 1-1

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Clinical Practice ◽

Intensive Care Medicine ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Japanese Society ◽

Sepsis And Septic Shock

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The Role of Serum Procalcitonin in Predicting Bacterial Sepsis in Patients With Hypothyroidism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-01082 ◽

2019 ◽

Vol 104 (12) ◽

pp. 5915-5922

Author(s):

Aditya S Shirali ◽

James X Wu ◽

Catherine Y Zhu ◽

Alfonso Ocampo ◽

Chi-Hong Tseng ◽

...

Keyword(s):

Septic Shock ◽

Test Performance ◽

Serum Levels ◽

Primary Hypothyroidism ◽

Bacterial Sepsis ◽

Thyroid C Cells ◽

Failure Assessment ◽

History Of ◽

Sepsis And Septic Shock ◽

Design And Methods

Abstract Context Serum levels of procalcitonin (PCT), a protein produced by the thyroid C cells under physiologic conditions, are high during sepsis. Objective To assess the test performance of serum PCT in predicting bacterial sepsis and septic shock in patients with hypothyroidism compared with those who have euthyroidism. Design and Methods This retrospective study evaluated patients with no history of thyroid dysfunction (euthyroid), primary hypothyroidism [medical hypothyroidism (MH)], and postsurgical hypothyroidism from total thyroidectomy (TT) identified from a prospectively maintained database who had PCT testing from 2005 to 2018. Quick Sequential Organ Failure Assessment score ≥ 2 or positive bacterial cultures identified bacterial sepsis, and a mean arterial pressure less than 65 mm Hg or a vasopressor requirement defined septic shock. Sensitivity and specificity of PCT for evaluation of bacterial sepsis and septic shock were measured. Results We identified 217 euthyroid patients, 197 patients with MH, and 84 patients with TT. Bacterial sepsis was found in 98 (45.2%), 92 (46.7%), and 36 (42.9%) of these patients, respectively (P > 0.05). Septic shock was identified in 13 (6.0%), 13 (6.6%), and 5 (6.0%) patients (P > 0.05), respectively. With use of a PCT cutoff of 0.5 µg/L for bacterial sepsis, the sensitivity was 59%, 61%, and 53% (P > 0.05) and specificity was 81%, 77%, and 81% (P > 0.05) for the diagnosis of bacterial sepsis in euthyroid, MH, and TT patients, respectively. With use of a PCT cutoff of 2.0 µg/L for septic shock, the sensitivity was 46%, 62%, and 63% (P > 0.05) and specificity was 86%, 82%, and 91% (P > 0.05) for the diagnosis of septic shock in these patients, respectively. Conclusions Despite the thyroidal origin of PCT, hypothyroidism did not affect the diagnostic performance of serum PCT levels in predicting bacterial sepsis or septic shock.

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