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-  2019 

Clindamycin clearance during Cytosorb? hemoadsorption: A case report and pharmacokinetic study

DOI: 10.1177/0391398819831303

Keywords: Adsorbents,antibiotics,hemoperfusion,infection,paediatric ECMO,plasma clearance,sepsis,treatment of bacterial infections,artificial kidney,apheresis & detoxification techniques

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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 necessar

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