CASE REPORT: USE OF THE SERAPH-100 BLOOD FILTER IN LINE WITH EXTRACORPOREAL MEMBRANE OXYGENATION CIRCUIT FOR TREATMENT OF SEPTIC SHOCK FROM ENTEROCOCCUS FAECALIS BACTEREMIA
Chest
; 162(4):A1012-A1013, 2022.
Article
in English
| EMBASE | ID: covidwho-2060751
ABSTRACT
SESSION TITLE Close Critical Care Calls SESSION TYPE Case Reports PRESENTED ON 10/18/2022 1115 am - 1215 pm INTRODUCTION:
With the development of resistant organisms, additional therapies are needed to effectively treat patients with severe infections. The Seraph®-100 Microbind Affinity Blood Filter utilizes immobilized heparinized microbeads, acting similar as the human glycocalyx, to bind and remove these substrates. In vitro and pre-clinical studies have shown up to 99% clearance of Enterococcus faecalis exposed to the Seraph®-100 blood filter. This novel extracorporeal blood purification system could assist with infection source control and reduction of vasopressor requirements. CASE PRESENTATION A 30-year-old male with no significant past medical history was admitted due to severe ARDS secondary to COVID-19 infection and required extracorporeal membrane oxygenation (ECMO) after an unsuccessful trial of conventional supportive therapies. The patient's hospital course was complicated by multiple infections, including bacteremia from methicillin susceptible Staphylococcus aureus, candidemia and Enterobacter ventilator associated pneumonia. These infections initially improved with use of appropriate intravenous antimicrobials. However, the patient experienced an acute hemodynamic decompensation requiring multiple vasoactive medications. He was empirically started on broad spectrum anti-microbials including meropenem, vancomycin, and isavuconazole. Blood cultures revealed Enterococcus faecalis, susceptible to broad-spectrum antibiotics. After 24 hours of broad-spectrum antimicrobials without improvements in vasopressor requirements, the Seraph-100® blood filter was used in-parallel with the ECMO circuit. Immediate improvement in vasopressors was noted with discontinuation of vasopressin and decrease in norepinephrine by 75%. The patient finished a 2-week course of intravenous ampicillin/sulbactam. His respiratory status subsequently improved and he was able to be removed from ECMO 24 days later.DISCUSSION:
Initial studies have shown the Seraph-100 is capable of clearing the SARS-Cov-2 virus and use has been associated with decreased mortality in patients with SARS-Cov-2. The ability to remove additional pathogens including bacteria, fungi and viruses would aid in obtaining source control and augment the effects of intravenous antibiotics. This case not only illustrates the benefits with the use of the Seraph ®-100 blood filter along with broad spectrum antibiotics, but also the ability to use this extracorporeal blood purification system in-line with ECMO.CONCLUSIONS:
With the emergence of multi-drug resistant pathogens, additional treatment options are urgently needed. The Seraph®-100 may be a useful adjunct to broad spectrum antimicrobials and may improve hemodynamics in patients with vasopressor-dependent septic shock. Further prospective studies are needed to assess clinical improvements with the use of the Seraph-100 Microbind blood filter in patients with bacteremia and those requiring ECMO. Reference #1 Olson SW, Oliver JD, Collen J, et al. Treatment for Severe Coronavirus Disease 2019 With the Seraph 100 Microbind Affinity Blood Filter. Critical Care Explor. 2020;2(8)e0180. Reference #2 Chitty, Stephen, Mobbs, Sarah, Chung, Kevin et al., for the PURIFY INVESTIGATORS. A Multicenter Evaluation of Blood Purification with Seraph 100 Microbind Affinity Blood Filter for the Treatment of Severe COVID-19 A Preliminary Report. medRxiv 2021.04.20.21255810;doi https//doi.org/10.1101/2021.04.20.21255810 Reference #3 Seffer, Malin-Theres, et al. "Heparin 2.0 a new approach to the infection crisis.” Blood Purification 50.1 (2021) 28-34. DISCLOSURES No relevant relationships by Joshua Boster No relevant relationships by Henry Danchi Speaker/Speaker's Bureau relationship with Janssen Please note $1001 - $5000 by Michael Morris, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note $1001 - $5000 by Michael Morris, value=Honoraria Removed 03/29/2022 by Michael Morris No releva t relationships by Mai Nguyen No relevant relationships by Melissa Rosas No relevant relationships by Steven Stoffel No relevant relationships by Robert Walter
antibiotic agent; endogenous compound; heparin; hypertensive factor; isavuconazole; meropenem; noradrenalin; sultamicillin; vancomycin; vasopressin; adult; adult respiratory distress syndrome; adverse device effect; antibiotic sensitivity; artificial ventilation; bacteremia; blood culture; blood filter; blood purification; candidemia; coinfection; complication; conference abstract; coronavirus disease 2019; drug combination; drug therapy; drug withdrawal; Enterococcus faecalis; extracorporeal membrane oxygenation device; extracorporeal oxygenation; fungus; hemodynamics; human; infectious agent; intensive care; intravenous drug administration; major clinical study; male; medical history; Melissa officinalis; methicillin susceptible Staphylococcus aureus; mortality; multicenter study (topic); nonhuman; prospective study; radius head prosthesis; septic shock; Severe acute respiratory syndrome coronavirus 2; ventilator associated pneumonia
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Databases of international organizations
Database:
EMBASE
Type of study:
Case report
Language:
English
Journal:
Chest
Year:
2022
Document Type:
Article
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