Clindamycin clearance during Cytosorb® hemoadsorption: A case report and pharmacokinetic study. Issue 5 (May 2019)

• Record Type: Journal Article
• Authors: Poli, Elettra Camille; Simoni, Chiara; André, Pascal; Buclin, Thierry; Longchamp, David; Perez, Marie-Hélène; Ferry, Thomas; Schneider, Antoine Guillaume
• Is Part Of: International journal of artificial organs. Volume 42:Issue 5(2019)
• Page Start: 258
• Page End: 262
• Publication Date: 2019-05
• Subjects: Adsorbents -- antibiotics -- hemoperfusion -- infection -- paediatric ECMO -- plasma clearance -- sepsis -- treatment of bacterial infections -- artificial kidney -- apheresis & detoxification techniques; Artificial organs -- Periodicals; 617.956
• DOI: 10.1177/0391398819831303
• Languages: English
• ISSNs: 0391-3988

Abstract

Panton-Valentine leucocidin producing methicillin-resistant Staphylococcus aureus infections are rare but associated with very high mortality rates. We report the case of a 14-year-old patient with Panton-Valentine leucocidin producing methicillin-resistant Staphylococcus aureus infection and Influenza B pneumonia requiring veno-arterial extra-corporeal membrane oxygenator for refractory shock. In the absence of response to conventional therapy, we have inserted a Cytosorb® cartridge within the extra-corporeal membrane oxygenator circuit. A spectacular decrease in vasopressor requirements followed. Since clindamycin, a key component of Panton-Valentine leucocidin producing methicillin-resistant Staphylococcus aureus treatment, might be removed by Cytosorb® hemoadsorption, we have performed serial plasma concentrations measurements of the drug. Based on these measurements, we were able to develop a pharmacokinetic model incorporating variable plasma clearance. Patient's exposure was estimated before, during and after Cytosorb® hemoadsorption. According to this model, Cytosorb® hemoadsorption did not seem to result in significant clindamycin removal. Cytosorb® hemoadsorption during Panton-Valentine leucocidin producing methicillin-resistant Staphylococcus aureus infection appears safe and feasible and no adaptation of clindamycin dosage seems necessary