Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report
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%), an...
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| Format: | Article |
| Language: | English |
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BMC
2018-03-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s13256-018-1611-5 |
| _version_ | 1818540536416436224 |
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| author | Vincenzo Pota Maria Beatrice Passavanti Pasquale Sansone Maria Caterina Pace Filomena Peluso Alfonso Fiorelli Caterina Aurilio |
| author_facet | Vincenzo Pota Maria Beatrice Passavanti Pasquale Sansone Maria Caterina Pace Filomena Peluso Alfonso Fiorelli Caterina Aurilio |
| author_sort | Vincenzo Pota |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T21:56:40Z |
| format | Article |
| id | doaj.art-84ff10e867a244209e6f1df2313bbe56 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-11T21:56:40Z |
| publishDate | 2018-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-84ff10e867a244209e6f1df2313bbe562022-12-22T00:49:17ZengBMCJournal of Medical Case Reports1752-19472018-03-011211710.1186/s13256-018-1611-5Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case reportVincenzo Pota0Maria Beatrice Passavanti1Pasquale Sansone2Maria Caterina Pace3Filomena Peluso4Alfonso Fiorelli5Caterina Aurilio6Department of Women, Infant and Surgical and Specialist Surgery, University of Campania “L. Vanvitelli”Department of Women, Infant and Surgical and Specialist Surgery, University of Campania “L. Vanvitelli”Department of Women, Infant and Surgical and Specialist Surgery, University of Campania “L. Vanvitelli”Department of Women, Infant and Surgical and Specialist Surgery, University of Campania “L. Vanvitelli”Department of Women, Infant and Surgical and Specialist Surgery, University of Campania “L. Vanvitelli”Thoracic Surgery Unit, University of Campania “L. Vanvitelli”Department of Women, Infant and Surgical and Specialist Surgery, University of Campania “L. Vanvitelli”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.http://link.springer.com/article/10.1186/s13256-018-1611-5Septic shockIgM-enriched immunoglobulin preparationPolymyxin B hemoperfusionMediastinitis |
| spellingShingle | Vincenzo Pota Maria Beatrice Passavanti Pasquale Sansone Maria Caterina Pace Filomena Peluso Alfonso Fiorelli Caterina Aurilio Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report Journal of Medical Case Reports Septic shock IgM-enriched immunoglobulin preparation Polymyxin B hemoperfusion Mediastinitis |
| title | Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report |
| title_full | Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report |
| title_fullStr | Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report |
| title_full_unstemmed | Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report |
| title_short | Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report |
| title_sort | septic shock from descending necrotizing mediastinitis combined treatment with igm enriched immunoglobulin preparation and direct polymyxin b hemoperfusion a case report |
| topic | Septic shock IgM-enriched immunoglobulin preparation Polymyxin B hemoperfusion Mediastinitis |
| url | http://link.springer.com/article/10.1186/s13256-018-1611-5 |
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