1. Septic shock from descending necrotizing mediastinitis - Combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: A case report
- Author
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Pasquale Sansone, Filomena Peluso, Alfonso Fiorelli, Vincenzo Pota, Maria Caterina Pace, Maria Beatrice Passavanti, Caterina Aurilio, Pota, Vincenzo, Passavanti, Maria Beatrice, Sansone, Pasquale, Pace, Maria Caterina, Peluso, Filomena, Fiorelli, Alfonso, and Aurilio, Caterina
- Subjects
Male ,Carbapenem ,medicine.medical_treatment ,Antibiotics ,lcsh:Medicine ,Case Report ,Polymyxin B hemoperfusion ,030204 cardiovascular system & hematology ,medicine.disease_cause ,0302 clinical medicine ,Drug Resistance, Multiple, Bacterial ,Septic shock ,030212 general & internal medicine ,Polymyxin B ,biology ,General Medicine ,Hemoperfusion ,Mediastinitis ,Combined Modality Therapy ,Shock, Septic ,Anti-Bacterial Agents ,Intensive Care Units ,Treatment Outcome ,Thoracotomy ,Staphylococcus aureus ,Mediastiniti ,Ventilator Weaning ,medicine.drug ,Adult ,medicine.drug_class ,Gram-Positive Bacteria ,Microbiology ,03 medical and health sciences ,Necrosis ,Gram-Negative Bacteria ,medicine ,Humans ,IgM-enriched immunoglobulin preparation ,business.industry ,lcsh:R ,medicine.disease ,Respiration, Artificial ,Immunoglobulin M ,biology.protein ,business ,Neck - Abstract
Background Descending necrotizing mediastinitis is a common and progressive polymicrobial infection involving the neck and chest with a high death rate (10 to 40%). From a microbiological point of view, descending necrotizing mediastinitis is sustained by Gram-positive bacteria (43–62%), anaerobes (46–78%), and, rarely, Gram-negative bacteria. Data collected during the Antibiotic Resistance-Istituto Superiore di Sanità project confirmed that Italy is positioned among the countries with the highest levels of resistance in most pathogenic species under surveillance. In particular, 32.9% of Klebsiella pneumoniae isolates were resistant to carbapenem, 33.6% of Staphylococcus aureus to methicillin, and 28.7% and 43.9% of Escherichia coli isolates to third-generation cephalosporins and fluoroquinolones, respectively. Case presentation We describe the case of a 38-year-old white man with septic shock due to descending necrotizing mediastinitis sustained by multidrug-resistant Gram-negative and Gram-positive bacteria treated after surgery with an IgM-enriched immunoglobulin preparation and polymyxin B hemoperfusion therapy. Conclusion Despite the contrasting data on the use of immunoglobulins and polymyxin B hemoperfusion in septic shock and the lack of literature in cases of acute mediastinitis caused by both Gram-negative and Gram-positive multidrug-resistant bacteria, we obtained an improvement in clinical conditions and the survival of our patient, against all odds.
- Published
- 2018