The advanced organ support (ADVOS) system allows to eliminate water-soluble as well as protein-bound molecules. Despite its clinical features, to date nothing is known about the elimination of clinically relevant drugs such as antiinfectives. Therefore, we report a case treated with ADVOS, continuous renal replacement therapy (CRRT), and meropenem (1 g 8-hourly) for empiric sepsis therapy monitored by meropenem drug levels. ADVOS showed more efficient elimination of meropenem compared to CRRT which has to be considered when evaluating dosing regimens.
VincentJ-LLefrantJ-YKotfisK, et al. Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP). Intensive Care Med2018; 44: 337–344.
2.
HorvatitsTDrolzATraunerM, et al. Liver injury and failure in critical illness. Hepatology2019; 70: 2204–2215.
3.
FuhrmannVPerez Ruiz de GaribayAFaltlhauserA, et al. Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system: 2-year interim analysis. Medicine (Baltimore)2021; 100: e24653.
4.
NeriMVillaGGarzottoF, et al. Nomenclature for renal replacement therapy in acute kidney injury: basic principles. Crit Care2016; 20: 318.
5.
HuberWRuiz de GaribayAP. Options in extracorporeal support of multiple organ failure. Med Klin2020; 115: 28–36.
6.
JarczakDKlugeSFuhrmannV. Successful therapy of massive risperidone-induced rhabdomyolysis using different dialysis and adsorber devices: a case report. Artif Organs2019; 43: 1113–1115.
7.
FuhrmannVWeberTRoedlK, et al. Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure. Ann Intensive Care2020; 10: 96.
8.
VardakasKZVoulgarisGLMaliarosA, et al. Prolonged versus short-term intravenous infusion of antipseudomonal beta-lactams for patients with sepsis: a systematic review and meta-analysis of randomised trials. Lancet Infect Dis2018; 18: 108–120.
9.
JalanRSalibaFPavesiM, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol2014; 61: 1038–1047.
10.
Nilsson-EhleIHutchisonMHaworthSJ, et al. Pharmacokinetics of meropenem compared to imipenem-cilastatin in young, healthy males. Eur J Clin Microbiol Infect Dis1991; 10: 85–88.
11.
AdnanSLiJXWallisSC, et al. Pharmacokinetics of meropenem and piperacillin in critically ill patients with indwelling surgical drains. Int J Antimicrob Agents2013; 42: 90–93.
12.
Gonçalves-PereiraJPóvoaP. Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of β-lactams. Crit Care2011; 15: R206.
13.
ChristenssonBANilsson-EhleIHutchisonM, et al. Pharmacokinetics of meropenem in subjects with various degrees of renal impairment. Antimicrob Agents Chemother1992; 36: 1532–1537.
14.
RoehrACFreyORKoebererA, et al. Anti-infective drugs during continuous hemodialysis – using the bench to learn what to do at the bedside. Int J Artif Organs2015; 38: 17–22.
15.
PubChem. Meropenem (CID=441130). National Center for Biotechnology Information. PubChem Compound Summary for CID 441130, Meropenem. https://pubchem.ncbi.nlm.nih.gov/compound/Meropenem (accessed 4 April 2021).
16.
BrauneSKonigCRobertsJA, et al. Pharmacokinetics of meropenem in septic patients on sustained low-efficiency dialysis: a population pharmacokinetic study. Crit Care2018; 22: 25.
17.
SchroederTHKruegerWAHansenM, et al. Elimination of meropenem by continuous hemo(dia) filtration: an in vitro one-compartment model. Int J Artif Organs1999; 22: 307–312.
18.
TakasuYYoshidaMTangeM, et al. Prediction of the stability of meropenem in intravenous mixtures. Chem Pharm Bull (Tokyo)2015; 63: 248–254.
19.
GrensemannJBusseDKönigC, et al. Acute-on-chronic liver failure alters meropenem pharmacokinetics in critically ill patients with continuous hemodialysis: an observational study. Ann Intensive Care2020; 10: 48.
20.
GuilhaumouRBenaboudSBennisY, et al. Optimization of the treatment with beta-lactam antibiotics in critically ill patients-guidelines from the French Society of Pharmacology and Therapeutics (Societe Francaise de Pharmacologie et Therapeutique-SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (Societe Francaise d'Anesthesie et Reanimation-SFAR). Crit Care2019; 23: 104.
21.
Abdul-AzizMHLipmanJAkovaM, et al. Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort. J Antimicrob Chemother2016; 71: 196–207.
22.
Abdul-AzizMHAlffenaarJCBassettiM, et al. Antimicrobial therapeutic drug monitoring in critically ill adult patients: a position paper. Intensive Care Med2020; 46: 1127–1153.
23.
KönigCKlugeSWichaSG. Therapeutic drug monitoring of antiinfectives in intensive care unit patients - what’s new?Dtsch Med Wochenschr2020; 145(24): 1764–1769. (German).