Successful treatment of direct hemoperfusion with polymyxin B-immobilized fiber for septic shock and severe acute kidney injury due to ceftriaxone-resistant Escherichia coli: a case report with literature review

Renal Replacement Therapy

Megumi Harada¹  Yusuke Higashiguchi¹  Shunji Hashizume²  Takashi Iwase²  Takeshi Nishiuchi²  Takehiko Kimura²  Nobuyuki Takamori²  Manabu Tashiro³  Jun Minakuchi³  Tomoko Inoue³  Hisato Shima³  Kazuyoshi Okada³  Chiaki Masaki⁴  Taro Banno⁵  Masaaki Nishitani⁵  Naoki Nagasaka⁵  Ayako Ito⁵  Kazuhiko Kawahara⁶ 

[1] Clinical Engineering Department of Kawashima Hospital;Department of Cardiovascular Medicine, Kawashima Hospital;Department of Kidney Disease, Kawashima Hospital;Department of Laboratory, Kawashima Hospital;Department of Urology, Kawashima Hospital;Kamojima-Kawashima Clinic;

关键词: Polymyxin B-immobilized fiber;    Septic shock;    Acute kidney injury;   

DOI  :  10.1186/s41100-020-00266-z

来源: DOAJ

【 摘 要 】

Abstract Background Septic shock is a life-threatening condition and one of the most common causes of acute kidney injury. Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used to reduce endotoxin levels in blood. Here, we report a rare but important case of sepsis-induced acute kidney injury and septic shock, which was successfully treated with PMX-DHP in spite of inappropriate initial antibiotic therapy. Case presentation An 84-year-old man was hospitalized for septic shock and acute kidney injury. Although he was treated with ceftriaxone, he did not recover from hypotension and had reduced urine output. After initiating PMX-DHP on days 3 and 4, his blood pressure was immediately elevated and his white blood cell count and C-reactive protein levels improved. Because ceftriaxone-resistant Escherichia coli was identified in blood culture, we changed his antibiotics to levofloxacin on day 7. He successfully recovered from the septic shock and dialysis was withdrawn. Conclusions Considering the use of inappropriate initial antibiotics, the early induction of PMX-DHP might have been a key determinant of his outcome. PMX-DHP therapy should be considered in septic shock in addition to antibiotic treatment.

【 授权许可】

Unknown