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Related Experiment Video

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Automation of Bio-Atomic Force Microscope Measurements on Hundreds of C. albicans Cells
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Caspofungin sequestration in a polyacrylonitrile-derived filter: Increasing the dose does not mitigate sequestration.

Frédéric J Baud1, Vincent Jullien2, Marie Desnos-Ollivier3

  • 1Département d'Anesthésie-Réanimation Adulte-SAMU de Paris, Hôpital Necker; Assistance Publique-Hôpitaux de Paris, University Paris Cité, Paris, France.

International Journal of Antimicrobial Agents
|October 15, 2023
PubMed
Summary

Increasing caspofungin dosage does not prevent its sequestration in polyacrylonitrile filters during continuous renal replacement therapy. This highlights risks of using caspofungin with these filters, suggesting alternative antifungal agents or therapies.

Keywords:
CaspofunginContinuous renal replacement therapyEchinocandinsPharmacokineticsSequestrationTreatment failures

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Area of Science:

  • Pharmacology
  • Nephrology
  • Critical Care Medicine

Background:

  • Continuous renal replacement therapy (CRRT) is vital for critically ill patients.
  • Echinocandins, like caspofungin, are first-line treatments for candidemia.
  • Preliminary data indicated echinocandin sequestration within polyacrylonitrile filters.

Purpose of the Study:

  • To investigate if increasing caspofungin dosage can overcome sequestration in polyacrylonitrile filters.
  • To evaluate the impact of CRRT filters on caspofungin disposition.

Main Methods:

  • In vitro study using STX filters (polyacrylonitrile).
  • Caspofungin concentrations measured using liquid chromatography-mass spectrometry.
  • Drug disposition assessed using NeckEpur technology in a crystalloid medium.

Main Results:

  • Caspofungin was extensively eliminated within 6-hour sessions at both low and high doses.
  • Sequestration accounted for 96% of elimination at low dose and 88.5% at high dose.
  • Increasing caspofungin dose did not significantly reduce filter sequestration.

Conclusions:

  • Caspofungin sequestration in STX filters is not mitigated by higher doses.
  • Concurrent use of caspofungin and polyacrylonitrile filters warrants caution.
  • Alternative CRRT modes or antifungal agents (e.g., fluconazole) may be considered.