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- Title
Septic shock from descending necrotizing mediastinitis - combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report.
- Authors
Pota, Vincenzo; Passavanti, Maria Beatrice; Sansone, Pasquale; Pace, Maria Caterina; Peluso, Filomena; Fiorelli, Alfonso; Aurilio, Caterina
- Abstract
<bold>Background: </bold>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.<bold>Case Presentation: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
SEPTIC shock treatment; MEDIASTINITIS; IMMUNOGLOBULIN M; POLYMYXIN B; HEMOPERFUSION; THERAPEUTICS
- Publication
Journal of Medical Case Reports, 2018, Vol 12, Issue 1, p1
- ISSN
1752-1947
- Publication type
journal article
- DOI
10.1186/s13256-018-1611-5