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polymyxin b hemoperfusion

Etsuro Nanishi, Yuichirou Hirata, Sooyoung Lee, Noriyuki Kaku, Kenta Momii, Kensuke Kubota, Hisanori Nishio, Yoshihiko Maehara, Toshiro Hara
Toxic shock syndrome (TSS) is a critical illness associated with toxin from Staphylococcus aureus. Despite recent advances in critical care, mortality remains high and additional effective therapy is required. We report an adolescent case of TSS successfully treated with direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP). The patient with spina bifida also had ischial pressure ulcer, and developed TSS associated with methicillin-resistant S. aureus. Despite conventional treatment, the patient developed refractory shock, which was immediately improved with PMX-DHP...
October 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Hiroyuki Yamada, Tatsuo Tsukamoto, Hiromichi Narumiya, Kazumasa Oda, Satoshi Higaki, Ryoji Iizuka, Motoko Yanagita, Masako Deguchi
BACKGROUND: Direct hemoperfusion with polymyxin B-immobilized fiber column (PMX-DHP) could improve the hemodynamic status of septic shock patients. As PMX-DHP is an invasive and costly procedure, it is desirable to estimate the therapeutic effect before performing the therapy. However, it is still unclear when this therapy should be started and what type of sepsis it should be employed for. In this study, we retrospectively examined the clinical effect of patients treated with PMX-DHP by using central venous pressure (CVP)...
2016: Journal of Intensive Care
Hironobu Tsubouchi, Nobuhiro Matsumoto, Shigehisa Yanagi, Yasuji Arimura, Masamitsu Nakazato
Sepsis is a life-threatening condition caused by the inflammatory response to invading organisms. Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used to reduce blood endotoxin levels and modulate circulating inflammatory cytokine levels in sepsis patients. Here we report that severe sepsis caused by an infection of the gram-negative bacterium Pantoea agglomerans in a patient with small cell lung carcinoma was treated successfully with antibiotics and PMX-DHP. The patient, a 49-year-old Japanese male smoker whose condition was complicated with hyponatremia due to SIADH (syndrome of inappropriate secretion of antidiuretic hormone), rapidly developed sepsis and disseminated intravascular coagulation (DIC) after the administration of cisplatin and irinotecan...
2016: Respiratory Medicine Case Reports
Anna Sidoti, Etrusca Brogi, Joshua Morse, Michele Collareta, Luigi Vetrugno, Francesco Giunta, Francesco Forfori
Direct hemoperfusion with polymyxin B (PMX-DHP) is an extracorporeal treatment to add to conventional therapy during unresponsive endotoxic septic shock. So far, only heparin has been used as an anticoagulant during polymyxin B therapy. We present a case report of a postsurgical septic patient treated with 2 cycles of PMX-DHP using citrate anticoagulation. Monitoring of serum calcium, postcartridge calcium, and acid-base balance was performed. The treatments were accomplished without complications. To our knowledge, this is the first published report on the use of citrate anticoagulation during PMX-DHP...
December 1, 2016: A & A Case Reports
Yoriko Ishibe, Shigehiro Shibata, Gaku Takahashi, Yasushi Suzuki, Yoshihiro Inoue, Shigeatsu Endo
This study was undertaken to analyze the association of type II secretory phospholipase A2 (sPLA2 -II) and surfactant protein D (SP-D) with the pulmonary oxygenation potential in patients with septic shock during polymyxin-B immobilized fiber-direct hemoperfusion (PMX-DHP). The study was conducted in 25 patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). PMX-DHP lowered the blood endotoxin level in all patients. Following PMX-DHP, there were decreases from day 0 → day 1 → day 2 in both the mean plasma sPLA2 -II level (340 → 260 → 189 ng/mL) and plasma SP-D level (483 → 363 → 252 ng/mL)...
September 13, 2016: Journal of Clinical Apheresis
Risturo Arakawa, Nobuaki Mori, Narito Kagawa, Akiko Higuchi, Masashi Tanaka, Yasuko Aoki, Shiko Seki, Ryo Suzuki
Meningococcal infection is among the most devastating diseases. It is rarely seen in Japan. However, several environmental and host factors have been associated with increased risks of Neisseria meningitidis infection. We present a case of invasive N. meningitidis infection that revealed the presence of multiple myeloma. A 55-year-old Japanese man was admitted with fever and altered consciousness. He was sent to the intensive care unit for septic shock and disseminated intravascular coagulation. In addition to standard septic shock and multiple organ failure treatment, polymyxin-B immobilized column direct hemoperfusion was performed...
May 2016: Kansenshōgaku Zasshi. the Journal of the Japanese Association for Infectious Diseases
Itaru Ebihara, Kouichi Hirayama, Miho Nagai, Eri Shiina, Megumi Koda, Masanobu Gunji, Yuki Okubo, Chihiro Sato, Joichi Usui, Kunihiro Yamagata, Masaki Kobayashi
Acute kidney injury (AKI) occurs in approximately 50% of patients in septic shock, and mortality from septic AKI is extremely high. Angiopoietin levels may play a role in the pathogenesis of vascular permeability. It was reported that direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX) therapy ameliorates the angiopoietin balance in patients with sepsis. Although dysregulated angiopoietin balance in sepsis has been demonstrated, mechanisms underlying the development of AKI in sepsis have not been identified...
August 2016: Therapeutic Apheresis and Dialysis
Rémi Coudroy, Didier Payen, Yoann Launey, Anne-Claire Lukaszewicz, Mahmoud Kaaki, Benoit Veber, Olivier Collange, Antoine Dewitte, Laurent Martin-Lefevre, Matthieu Jabaudon, Thomas Kerforne, Martine Ferrandière, Eric Kipnis, Carlos Vela, Stéphanie Chevalier, Jihad Mallat, Sandrine Charreau, Jean-Claude Lecron, René Robert
Conflicting results have been reported on the influence of Polymyxin-B hemoperfusion treatment on systemic inflammation markers. The aim of study was to assess in a randomized control trial the influence on plasma cytokine concentrations of Polymyxin-B hemoperfusion in septic shock due to peritonitis. A panel of 10 pro- or anti-inflammatory cytokines was measured in 213 patients with peritonitis-induced septic shock enrolled in the randomized trial ABDOMIX testing the impact of 2 Polymyxin-B hemoperfusion sessions with standard treatment...
August 8, 2016: Shock
Salvatore Lucio Cutuli, Antonio Artigas, Roberto Fumagalli, Gianpaola Monti, Vito Marco Ranieri, Claudio Ronco, Massimo Antonelli
BACKGROUND: In 2010, the EUPHAS 2 collaborative group created a registry with the purpose of recording data from critically ill patients suffering from severe sepsis and septic shock treated with polymyxin-B hemoperfusion (PMX-HP) for endotoxin removal. The aim of the registry was to verify the application of PMX-HP in the daily clinical practice. METHODS: The EUPHAS 2 registry involved 57 centers between January 2010 and December 2014, collecting retrospective data of 357 patients (297 in Europe and 60 in Asia) suffering from severe sepsis and septic shock caused by proved or suspected infection related to Gram negative bacteria...
December 2016: Annals of Intensive Care
Tomonori Takazawa, Jou Ohta, Tatsuo Horiuchi, Hiroshi Hinohara, Fumio Kunimoto, Shigeru Saito
BACKGROUND: Gas gangrene is a necrotic infection of soft tissue associated with high mortality rates. We report a case of postoperative gas gangrene with very acute onset and rapid progression of symptoms. To our knowledge, this case is the most acute onset of postoperative gas gangrene ever reported. CASE PRESENTATION: A 65-year-old Japanese female patient developed a shock state 16 h after radical cystectomy with ileal conduit reconstruction. Two days after the operation, she was transferred to the intensive care unit because of deterioration in her respiratory and circulatory condition...
2016: BMC Research Notes
Shinya Chihara, Yoshiki Masuda, Hiroomi Tatsumi, Kota Nakano, Tomokazu Shimada, Takao Murohashi, Michiaki Yamakage
This study was conducted to clarify the effectiveness of induction timing of direct hemoperfusion with a polymyxin-B immobilized column (PMX-DHP) for amelioration of hemodynamic derangement and outcome in patients with septic shock. Suspected Gram-negative septic shock patients who received PMX-DHP therapy from January 2010 to December 2014 in our ICU were enrolled in this study. The patients were divided into two groups that received PMX-DHP therapy within 8 h (early group) and more than 8 h (late group) from catecholamine administration...
July 28, 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Kazuhito Minami, Yoshihisa Sakaguchi, Daisuke Yoshida, Manabu Yamamoto, Masahiko Ikebe, Masaru Morita, Yasushi Toh
BACKGROUND: Clostridium difficile (CD)-associated colitis (CDAC) is endemic and a common nosocomial enteric disease encountered by surgeons in modern hospitals due to prophylactic or therapeutic antibiotic therapies. Currently, the incidence of fulminant CDAC, which readily causes septic shock followed by multiple organ dysfunction syndromes, is increasing. Fulminant CDAC requires surgeons to perform a prompt surgery, such as subtotal colectomy, to remove the septic source. It is known that fulminant CDAC is caused by the shift from an inflammatory response at a local mucosal level to a general systemic inflammatory reaction in which CD toxin-induced mediators' cascades disseminate...
December 2016: Surgical Case Reports
Gianluigi Li Bassi, Joan Daniel Marti, Eli Aguilera Xiol, Talitha Comaru, Francesca De Rosa, Montserrat Rigol, Silvia Terraneo, Mariano Rinaudo, Laia Fernandez, Miguel Ferrer, Antoni Torres
BACKGROUND: Hemoperfusion through a column containing polymyxin B-immobilized fiber (PMX-HP) is beneficial in abdominal sepsis. We assessed the effects of PMX-HP in a model of severe Pseudomonas aeruginosa pneumonia. METHODS: Eighteen pigs with severe P. aeruginosa pneumonia were mechanically ventilated for 76 h. Pigs were randomized to receive standard treatment with fluids and vasoactive drugs, or standard treatment with two 3-h PMX-HP sessions. Antibiotics against P...
December 2016: Annals of Intensive Care
Takuya Ueno, Toshiaki Ikeda, Takayoshi Yokoyama, Yu Kihara, Osamu Konno, Yuki Nakamura, Hitoshi Iwamoto, Tetsunosuke Shimizu, Martina M McGrath, Anil Chandraker
Early recovery from shock improves prognosis in patients with severe sepsis and septic shock. During this period, cytokine imbalances mediate the development of organ damage and mortality. In Japan, we have access to hemoperfusion using an immobilized polymyxin B fiber column for endotoxin removal (PMX-DHP) and continuous hemodiafiltration (CHDF) as artificial support for patients with septic shock, with the aim of improving hemodynamics and organ dysfunction caused by elevated inflammatory cytokines and mediators...
July 2016: Cytokine
Takeshi Kuroda, Hiroyuki Takeuchi, Yukiko Nozawa, Hiroe Sato, Takeshi Nakatsue, Yoko Wada, Hiroshi Moriyama, Masaaki Nakano, Ichiei Narita
BACKGROUND: Pneumocystis jirovecii pneumonia (PCP) is potentially fatal infectious complication in patients with rheumatoid arthritis (RA) during immunosuppressive therapy. Hospital survival due to human immunodeficiency virus-unrelated PCP reaches to 60%. The high mortality rate results from difficulties in establishing an early diagnosis, concurrent use of prophylactic drugs, possible bacterial coinfection. We herein report a case of PCP in RA patients who developed the architectural distortions of lung in spite of combined modality therapy...
2016: BMC Research Notes
Kazumasa Emori, Nobuhiro Takeuchi, Junichi Soneda
A 50-year-old male was brought to our emergency department by ambulance with complaints of pain and numbness in both legs. At arrival, purple spots were evident on his neck and face. Examination of the vital sign indicated septic shock. Laboratory data and blood gas analysis revealed disseminated intravascular coagulation, multiple organ failure, and metabolic acidosis. Peripheral blood smears revealed Howell-Jolly bodies, indicating decreased splenic function. A rapid urinary pneumococcal antigen test was also found to be positive...
2016: Case Reports in Critical Care
Masao Iwagami, Hideo Yasunaga, Eisei Noiri, Hiromasa Horiguchi, Kiyohide Fushimi, Takehiro Matsubara, Naoki Yahagi, Masaomi Nangaku, Kent Doi
BACKGROUND/AIMS: We assessed the survival benefit of polymyxin B hemoperfusion (PMX) in septic shock patients starting continuous renal replacement therapy (CRRT), who are known to have an increased rate of mortality. METHODS: Adult patients in the Japanese diagnosis procedure combination database satisfying the following criteria were enrolled: hospitalized in 2007-2012; diagnosed as having sepsis; required noradrenaline and/or dopamine; and started CRRT in intensive care unit...
2016: Blood Purification
Chieko Mitaka, Takahiro Masuda, Koji Kido, Tokujiro Uchida, Shinya Abe, Taku Miyasho, Makoto Tomita, Eiichi Inada
BACKGROUND: Direct hemoperfusion with a polymyxin B-immobilized column (PMX-DHP) adsorbs endotoxin and has been used for the treatment of septic shock. Yet, the mechanisms by which PMX-DHP acts on acute kidney injury are only partially understood. MATERIALS AND METHODS: Rats were anesthetized, tracheostomized, and placed on mechanical ventilation. The animals were randomized to three groups: a cecal ligation and puncture (CLP) + dummy-DHP group (n = 10), a CLP + PMX-DHP group (n = 10), and a sham group (n = 4)...
March 2016: Journal of Surgical Research
Nicholas Heming, Laure Lamothe, Xavier Ambrosi, Djillali Annane
INTRODUCTION: The incidence of sepsis, the systemic inflammatory response of the host to an infectious insult, has steadily increased over past decades. This trend is expected to continue. Sepsis is a leading cause of death and disability worldwide. Treatment relies on antibiotics associated to source control and supportive care. Major progress has been made in the understanding and overall management of sepsis. However, there is no specific treatment for sepsis. AREAS COVERED: We searched PubMed and the ClinicalTrials...
2016: Expert Opinion on Emerging Drugs
Naoto Nishizaki, Mayu Nakagawa, Satoshi Hara, Hisayuki Oda, Masato Kantake, Kaoru Obinata, Yuki Uehara, Keiichi Hiramatsu, Toshiaki Shimizu
We report a case of early onset sepsis caused by (CTX for cefotaximase and M for Munich)-type extended-spectrum β-lactamase-producing Escherichia coli (ESBL E. coli) in a preterm infant weighing 601 g. He was given meropenem and treated for endotoxin absorption with polymyxin B-immobilized fibers with only 8 mL of priming volume. The patient survived without any short-term neurological or respiratory sequelae. The choice of antibiotics is particularly important in seriously ill neonates with sepsis due to ESBL-producing organisms...
December 29, 2015: Pediatrics International: Official Journal of the Japan Pediatric Society
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