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Antimicrobial Agents and Chemotherapy, March 2008, p. 1009-1013, Vol. 52, No. 3
0066-4804/08/$08.00+0     doi:10.1128/AAC.00858-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Adsorption of Amikacin, a Significant Mechanism of Elimination by Hemofiltration{triangledown}

Qi Tian,1 Charles D. Gomersall,1* Margaret Ip,2 Perpetua E. Tan,1 Gavin M. Joynt,1 and Gordon Y. S. Choi1

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong,1 Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong2

Received 30 June 2007/ Returned for modification 9 September 2007/ Accepted 9 December 2007

We used an in vitro model of continuous venovenous hemofiltration (CVVH) to characterize amikacin adsorption by polyacrylonitrile (PAN) and polyamide filters. A blood-crystalloid mixture dosed with amikacin was pumped from a reservoir through a hemofiltration circuit and back to the reservoir. All ultrafiltrate was also returned to the reservoir. The level of adsorption was calculated from the fall in the amikacin concentration. The dose and the initial concentration of amikacin were varied, as were the pH, the type of hemofilter, and the hemofilter surface area. The reversibility of adsorption and the effect of repeated dosing were also studied. The level of adsorption by 0.6-m2 PAN filters was significantly greater than that by 0.6-m2 polyamide filters. Adsorption was increased by increasing the dose of amikacin even when the initial concentration was unchanged. It was unaffected by the pH (pH 6.8 or 7.4) or the hemofilter surface area (0.6 m2 or 0.9 m2). Repeated doses of amikacin resulted in further adsorption. In a saturation experiment, the maximum adsorptive capacity of 0.6-m2 PAN hemofilters was at least 546.9 mg (range, 427.6 to 577.5 mg). The adsorption of amikacin by hemofilters is irreversible and was associated with the dose and the hemofilter material but not the hemofilter surface area. Close monitoring of peak amikacin levels should be considered for patients receiving CVVH with PAN hemofilters.

* Corresponding author. Mailing address: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong. Phone: 852 2632 2734. Fax: 852 2637 2422. E-mail: gomersall{at}cuhk.edu.hk

{triangledown} Published ahead of print on 17 December 2007.

Antimicrobial Agents and Chemotherapy, March 2008, p. 1009-1013, Vol. 52, No. 3
0066-4804/08/$08.00+0     doi:10.1128/AAC.00858-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.





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