Impact of adsorptive CRRT membranes on vancomycin pharmacokinetics in critically ill patients

adsorption remains unclear and warrants further investigation. Nevertheless, overlooking the additional clearance contributed by AN69ST or oXiris membranes during dose regimen design may lead to subtherapeutic vancomycin exposure, thereby increasing the risk of treatment failure and antimicrobial resistance. This article systematically reviews the current evidence on vancomycin elimination characteristics with adsorptive membranes, with an emphasis on adsorption mechanisms, influencing factors, and clinical dosing adjustment strategies. In current clinical practice, intensified therapeutic drug monitoring with dynamic dose adjustment based on measured concentrations remains an essential strategy to ensure the efficacy and safety of vancomycin therapy. A deeper understanding of membrane-specific adsorption kinetics is required to optimize antibiotic dosing in critically ill patients receiving CRRT with highly adsorptive membranes.