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Sequestration of Antimicrobial Agents in Xcoating and Heparin-Coated Extracorporeal Membrane Oxygenation Circuits: An
Takafumi Kato1, Tomoyuki Enokiya2, Yoshihiko Morikawa3
1From the Department of Medical Engineer, Mie University Hospital, Tsu, Japan.
Abstract:
Limited data exist to guide antimicrobial therapy commonly prescribed to patients undergoing extracorporeal membrane oxygenation (ECMO). This study aimed to describe the kinetics of the cefazolin, doripenem, daptomycin, and levofloxacin in heparin-coated and Xcoating ECMO circuits. Circuits were primed with bovine whole blood and maintained at a physiological pH and temperature for 24 h. Each antimicrobial agent was added to the whole blood before priming. Equivalent doses of these drugs were added to glass jars containing fresh bovine whole blood as a control. Serial blood samples were collected from the ECMO circuits and controls over 24 h, and drug concentrations were quantified using validated assays. The concentrations of cefazolin, doripenem, daptomycin, and levofloxacin did not decrease significantly over 24 h. Collectively, these antimicrobial agents can be administered without the need to consider sequestration when using either heparin-coated or Xcoating circuits.
Insights
Antimicrobial drug levels remained stable in extracorporeal membrane oxygenation (ECMO) circuits. Cefazolin, doripenem, daptomycin, and levofloxacin showed no significant decrease over 24 hours in heparin-coated or Xcoating circuits.
Area of Science:
- Pharmacokinetics
- Biomedical Engineering
- Infectious Disease Management
Background:
- Limited data exist on antimicrobial drug behavior in extracorporeal membrane oxygenation (ECMO) circuits.
- Optimizing antimicrobial therapy is crucial for patients requiring ECMO support.
Purpose of the Study:
- To investigate the pharmacokinetic profiles of cefazolin, doripenem, daptomycin, and levofloxacin in ECMO circuits.
- To evaluate drug stability in both heparin-coated and Xcoating ECMO circuits over a 24-hour period.
Main Methods:
- Bovine whole blood was used to prime ECMO circuits (heparin-coated and Xcoating) and control systems.
- Four antimicrobial agents were added to the blood, and concentrations were measured over 24 hours.
- Drug concentrations were quantified using validated assays in serial blood samples.
Main Results:
- Cefazolin, doripenem, daptomycin, and levofloxacin concentrations did not significantly decrease in either ECMO circuit type over 24 hours.
- Drug stability was maintained in both heparin-coated and Xcoating circuits.
- No significant sequestration of these antimicrobials was observed.
Conclusions:
- Cefazolin, doripenem, daptomycin, and levofloxacin can be safely administered to patients on ECMO without dose adjustments for circuit sequestration.
- These findings support current antimicrobial prescribing practices for ECMO patients using these specific circuits.
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