Septic shock secondary to β-hemolytic streptococcus-induced necrotizing fasciitis treated with a novel cytokine adsorption therapy
Int J Artif Organs 2014; 37(5): 422 - 426
Article Type: SHORT COMMUNICATION
Article Subject: Artificial kidney, apheresis and detoxification techniques
Hubert Hetz, Reinhard Berger, Peter Recknagel, Heinz Steltzer
- Heinz Steltzer
- UKH Meidling
- Kundratstr. 37
- 1120 Vienna
Numerous animal studies and preliminary data from a clinical trial in septic patients demonstrated that a decrease in blood cytokine levels using an extracorporeal cytokine filter (CytoSorb™) can effectively attenuate the inflammatory response during sepsis and possibly improve outcomes.
A 60-year-old female was admitted to hospital due to a forearm fracture. After surgical wound care by osteosynthesis the patient developed surgical wound infection which progressed to necrotizing fasciitis. All diagnostic criteria for SIRS were evident with additional proven infection from β-hemolytic streptococcus. On admission to the ICU, the patient presented a full picture of multiple organ dysfunction syndrome due to septic shock including kidney failure, lung failure as well as thrombocytopenia, metabolic acidosis, and arterial hypotension.
After one day on mechanical ventilation and an IL-6 level of 70 000 pg/ml the patient was treated with CytoSorb therapy over a period of four days, resulting in a significant reduction of IL-6 to 66 pg/ml and an overall improvement of the patient’s condition. Despite the necessity of enucleation, the patient was successfully stabilized until control of the surgical infectious source was achieved. Importantly, treatment was safe and well-tolerated, without any adverse events.
This is the first report of the clinical application of CytoSorb hemoadsorption in combination with a CRRT in a patient with septic shock. CytoSorb as described was able to significantly reduce IL-6 plasma levels and decrease vasopressor need while no adverse and device-related events occurred. CytoSorb seems to be an interesting and safe extracorporeal therapy to stabilize and bridge septic patients to surgery or recovery.
- • Accepted on 11/19/2013
- • Available online on 4/17/2014
- • Published in print on 6/15/2014
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- Hetz, Hubert [PubMed] [Google Scholar] 1
- Berger, Reinhard [PubMed] [Google Scholar] 1
- Recknagel, Peter [PubMed] [Google Scholar] 2
- Steltzer, Heinz [PubMed] [Google Scholar] 1, * Corresponding Author (email@example.com)
AUVA Meidling Emergency Hospital, Department of Anesthesiology and Intensive Care Medicine, Vienna - Austria
Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena - Germany