Polymixin-B hemoperfusion in a case intolerant to conventional antibiotic therapy

Gilnardo Novelli, Vincenzo Morabito, Giancarlo Ferretti, Simone Novelli, Franco Ruberto, Milena Pernice, Cristina Cristina Donfrancesco, Perluigi Benedetti Panici

Department “Paride Stefanini” General Surgery and Organs Transplant, Sapienza University, Rome, Italy.
Department “Paride Stefanini” General Surgery and Organs Transplant, Sapienza University, Rome, Italy 2Department of.
Department of Anesthesia and Intensive Care, Sapienza University, Rome, Italy 5Department of.
Department of Clinical Engineering, Sapienza University, Rome, Italy.
Department of Gynecology and Obstretics, Sapienza University, Rome, Italy.
Department of Tropical and Infectous Disease, Sapienza University, Rome, Italy.

DOI: 10.4236/jbise.2012.53013                

Abstract

In this study we document how it was possible to resolve the septic complications of abdominal surgery, subjecting a patient severely allergic to intravenous antibiotics. We performed the hemoperfusion with polymyxin-B columns (PMX-DHP), guiding the therapy by assaying endotoxin activity and evaluating the clinical status of the patient after each session of PMX-DHP. The stabilization of hemodynamic and inflammatory frameworks were immediately observed after the PMX-DHP. The patient could be safely discharged five days after the discontinuation of the therapy. Our findings confirms data already published in literature concerning the effectiveness of PMX-DHP.

Keywords

Sepsis; Endotoxin Activity; Antibiotics

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Tani, T., Shoji, H., Guadagni, G. and Perego, A. (2010) Extracorporeal removal of endotoxin: The polymyxin B-immobilized fiber cartridge. Contributions to Nephrology, 167, 35-44. doi:10.1159/000315917
[2]	Cruz, D.N., Perazella, M.A., Bellomo, R., et al. (2007) Effectiveness of polymyxin B-immobilized fiber column in sepsis: A systematic review. Critical Care, 11, R47. doi:10.1186/cc5780
[3]	Cantaluppi, V., Assenzio, B., Pasero, D., et al. (2008) Polymyxin-B hemoperfusion inactivates circulating proapoptotic factors. Intensive Care Medicine, 34, 1638-1645. doi:10.1007/s00134-008-1124-6
[4]	Shoji, H. (2003) Extracorporeal endotoxin removal for the treatment of sepsis: Endotoxin adsorption cartridge (Toraymyxin). Therapeutic Apheresis and Dialysis, 7, 108-114. doi:10.1046/j.1526-0968.2003.00005.x
[5]	Shimizu, T., Yoshihiro, E., Tsuchihashi, H., et al. (2006) Endotoxin apheresis for sepsis. Transfusion and Apheresis Science, 35, 271-282. doi:10.1016/j.transci.2006.06.006
[6]	Marshall, J.C., Foster, D., Vincent, J.L., et al. (2004) Diagnostic and prognostic implications of endotoxemia in critical illness: Results of the MEDIC study. Journal of Infectious Diseases, 190, 527-534. doi:10.1086/422254
[7]	Monti, G., Bottiroli, M., Pizzilli, G., et al. (2010) Endotoxin activity level and septic shock: A possible role for specific anti-endotoxin therapy? Contributions to Nephrology, 167, 102-110. doi:10.1159/000315924
[8]	Novelli, G., Ferretti, G., Ruberto, F., et al. (2010) Early management of endotoxemia using the endotoxin activity assay and polymyxin B-based hemoperfusion. Contributions to Nephrology, 167, 91-101. doi:10.1159/000315923
[9]	Romaschin, A.D., Harris, D.M., Ribeiro, M.B., et al. (1998) A rapid assay of endotoxin in whole blood using autologous neutrophil-dependent chemiluminescence. Journal of Immunological Methods, 212, 16-85. doi:10.1016/S0022-1759(98)00003-9
[10]	Hanasawa, K., Tani, T. and Kodama, M. (1989) New approach to endotoxic and septic shock by means of polymyxin B immobilized fiber. Surgery Gynecology & Obstetrics, 168, 323-331.
[11]	Shoji, H., Tani, T., Hanasawa, K. and Kodama, M. (1998) Extracorporeal endotoxin removal by polymyxin B immobilized fiber cartridge: Designing and antiendotoxin efficacy in the clinical application. Therapeutic Apheresis, 2, 3-12. doi:10.1111/j.1744-9987.1998.tb00066.x