Removal of meropenem and piperacillin during experimental hemoadsorption with the HA380 cartridge.

Introduction: Hemoadsorption can be used as adjunctive therapy for sepsis. However, there is limited evidence regarding its antibiotic removal. In this in vivo preclinical study, we aimed to evaluate the removal of meropenem and piperacillin with the HA380 hemoadsorption cartridge.

Methods: Healthy adult sheep (n = 6) received 2 g of meropenem, and 4 g of piperacillin intravenously for 30 minutes followed by hemoadsorption with a HA380 cartridge at a blood flow rate of 120 mL/min for 4 hours. The sorbent-based removal ratio, clearance, and mass removal were calculated at multiple time points.

Results: The sorbent-based removal ratio of meropenem decreased from 95.4% (SD 1.8) at 10 minutes to less than 20% at 4-hours of hemoadsorption. Its cumulative sorbent-based mass removal was 386.6 mg (SD 78.8) over 4 hours with 65.6 % (SD 7.1) occurring in the first 60 minutes. In contrast, the sorbent-based removal ratio of piperacillin decreased more gradually from 98.4% (SD 0.6) at 10 minutes to 37.4% (SD 7.2) at 4 hours. Its cumulative sorbent-based mass removal was 647.4 mg (SD 191.3) over 4 hours with 63.4% (SD 4.2) occurring in the first 60 minutes. The overall sorbent-based clearance of piperacillin was significantly greater than meropenem (Pgroup < 0.0001).

Conclusion: Hemoadsoprtion with the HA380 cartridge removed meropenem and piperacillin throughout a 4-hour period, with high clearances at the start. Our findings can be used to inform dosing decisions during hemoadsorption in septic patients, there may be the need to consider increasing the doses of these antibiotics by 15-25 % to prevent underdosing.