Polymyxin B and low-dose hydrocortisone treatment in a patient with uroseptic shock in a rural health unit

ABSTRACT Sepsis has a high mortality rate; thus, in the intensive care unit, early diagnosis and adjunctive treatments are crucial. However, generally, most patients with sepsis from rural area initially visit the emergency department at a rural hospital and are managed in general medical wards in Japan. Here we report on an 81-year-old Japanese female manifesting septic shock caused by the upper urinary tract infection of extended-spectrum beta-lactamase-producing Escherichia coli secondary to the left ureter obstruction by the urothelial carcinoma. Broad-spectrum antibiotics were administered. Although critical for the source control of infection, drainage of the ureteropelvic junction could not be performed immediately because of catecholamine-resistant hypotension. Hence, we administered polymyxin B-immobilized fiber column direct hemoperfusion, followed by low-dose hydrocortisone administration. After 8 hours of infusion, she recovered from the septic shock and successfully underwent emergency percutaneous nephrostomy. This presented strategy may provide a new resolution of catecholamine-resistant patients in urosepsis.

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508 Factors predicting septic shock after percutaneous nephrostomy tube placement for emergency drainage of upper urinary tract obstruction

European Urology Supplements ◽

10.1016/s1569-9056(14)60500-5 ◽

2014 ◽

Vol 13 (1) ◽

pp. e508

Author(s):

K. Nazmi ◽

A.M. Harraz ◽

M.H. Zahran ◽

H. Nabeeh ◽

H. Orban ◽

...

Keyword(s):

Septic Shock ◽

Urinary Tract ◽

Urinary Tract Obstruction ◽

Percutaneous Nephrostomy ◽

Upper Urinary Tract ◽

Tube Placement ◽

Nephrostomy Tube ◽

Upper Urinary Tract Obstruction

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Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock

World Journal of Gastrointestinal Surgery ◽

10.4240/wjgs.v11.i12.422 ◽

2019 ◽

Vol 11 (12) ◽

pp. 422-432

Author(s):

Jin Joo Kim ◽

Young Jun Park ◽

Ki Yoon Moon ◽

Jin Hyeong Park ◽

Yong Ki Jeong ◽

...

Keyword(s):

Septic Shock ◽

Polymyxin B ◽

Source Control ◽

Polymyxin B Hemoperfusion

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EFFECTIVENESS OF DRAINAGE FOR ACUTE OBSTRUCTIVE PYELONEPHRITIS SECONDARY TO URETERIC CALCULI

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.1.3 ◽

2019 ◽

pp. 19-25

Author(s):

Dinh Dam Le ◽

Xuan My Nguyen ◽

Truong An Nguyen ◽

Khoa Hung Nguyen ◽

Dinh Khanh Le

Keyword(s):

Blood Pressure ◽

Septic Shock ◽

Urinary Tract ◽

Percutaneous Nephrostomy ◽

Upper Urinary Tract ◽

Ureteral Catheter ◽

Laboratory Findings ◽

Female Ratio ◽

Ureteric Calculi ◽

Obstructive Pyelonephritis

Purposes: To evaluate the effectiveness drainage for acute obstructive pyelonephritis secondary to ureteric calculi. Materials and Methods: 45 patients with obstructive pyelonephritis due to urolithiasis were hospitalized between October 2015 and Mars 2018 at Hue University of Medicine and Pharmacy Hospital. Results: The male to female ratio was 1 : 5.5. The median age was 54.16 ± 10.29 years (range 34 – 74 years). The physical findings at the time of hospitalization were as follows: body temperature 38.87 ± 0.66°C, pulse rate 94.38 + 12.29/min, respiratory rate 24.62 ± 5.57/min, systolic blood pressure 120.11 ± 16.39 mmHg, diastolic blood pressure 73.66 ± 9.19 mmHg. The laboratory findings were as follows: WBC: 13.97 ± 5.27g/l, platelets 266.91 ± 139.932 g/l, serum creatinine 96.09 ± 34.023 umol/l, serum CRP 160.08 ± 96.42 mg/l, serum procalcitonin 9.21 ± 22.57 ng/ml. The average size of the stones was 15.89 ± 9.84 mm (5 - 47). 14 patients had a positive urine culture result. The SIRS in 39 patients (86.7%). 44 patients (97.8%) received transurethral stenting using a double-J ureteral catheter and 1 patient (2.2%) received percutaneous nephrostomy. All patients received antimicrobial therapies. After the drainage of the upper urinary tract and antimicrobial therapies, all patients were apyretic. The flank pain and of the costovertebral angle tenderness disappeared. The serum WBC, CRP and Procalcitonin were decreased. Conclusions: Upper urinary tract infection in the patient with obstructive urolithiasis is a urologic emergency. It is necessary to drainage early to avoid septic shock and eventually death. Key words: acute obstructive pyelonephritis secondary, ureteric calculi, septic shock

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MP8-14 FACTORS PREDICTING SEPTIC SHOCK AFTER PERCUTANEOUS NEPHROSTOMY TUBE PLACEMENT FOR EMERGENCY DRAINAGE OF UPPER URINARY TRACT OBSTRUCTION

The Journal of Urology ◽

10.1016/j.juro.2014.02.357 ◽

2014 ◽

Vol 191 (4S) ◽

Author(s):

Ahmed Harraz ◽

Mohamed Zahran ◽

Hossam Nabeeh ◽

Kirolos Nazmi ◽

Hesham Orban ◽

...

Keyword(s):

Septic Shock ◽

Urinary Tract ◽

Urinary Tract Obstruction ◽

Percutaneous Nephrostomy ◽

Upper Urinary Tract ◽

Tube Placement ◽

Nephrostomy Tube ◽

Upper Urinary Tract Obstruction

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Impact of polymyxin B hemoperfusion therapy on high endotoxin activity level patients after successful infection source control: a prospective cohort study

Scientific Reports ◽

10.1038/s41598-021-03055-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Won Young Lee ◽

Hee Ju Kim ◽

Eun Young Kim

Keyword(s):

Septic Shock ◽

High Risk ◽

Risk Group ◽

Polymyxin B ◽

Source Control ◽

Hospital Death ◽

Endotoxin Activity ◽

Risk Patients ◽

Hospital Deaths ◽

Polymyxin B Hemoperfusion

AbstractWe sought to evaluate the clinical implication of endotoxin levels in gram-negative bacilli (GNB)-induced abdominal septic shock patients with polymyxin B-hemoperfusion (PMX-HP) treatment. A prospective cohort of 60 patients who received surgical infectious source control for abdominal sepsis from January 2019 to December 2020 was included in the study. Endotoxin activity (EA) levels and Sequential Organ Failure Assessment (SOFA) scores were assessed immediately after surgery (baseline), 24, and 48 h post baseline. With receiver operating characteristic curves, the patients were stratified into two groups by the EA cut-off value (high-risk group vs low-risk group) and the clinical outcomes were compared. Logistic regression was performed to identify the clinical impact of PMX-HP on in-hospital death. Among the 31 high-risk patients (EA level ≥ 0.54), 16 patients (51.6%) received PMX-HP treatment and showed significant decreases in EA levels compared to patients who underwent conventional treatment only (− 0.34 vs − 0.12, p = 0.01). SOFA scores also showed significant improvement with PMX-HP treatment (12.8–8.9, p = 0.007). Fourteen in-hospital deaths occurred (45.2%), and PMX-HP treatment had a protective effect on in-hospital death (odds ratio (OR) 0.04, p = 0.03). In 29 low-risk patients (EA level < 0.54), seven patients (24.1%) received PMX-HP treatment and showed significant decreases in EA levels (0.46–0.16, p = 0.018). However, SOFA scores and in-hospital deaths were not improved by PMX-HP treatment. EA level significantly decreased after PMX-HP treatment and it may represent a therapeutic option to improve organ impairment and in-hospital death in septic shock patients with EA levels exceeding 0.54.

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Endotoxin and Cytokine Sequential Hemoadsorption in Septic Shock and Multi-Organ Failure

Blood Purification ◽

10.1159/000518229 ◽

2021 ◽

pp. 1-4

Author(s):

Juan Carlos Ruiz-Rodríguez ◽

Luis Chiscano-Camón ◽

Clara Palmada ◽

Adolf Ruiz-Sanmartin ◽

Marcos Pérez-Carrasco ◽

...

Keyword(s):

Septic Shock ◽

Intensive Care ◽

New Jersey ◽

Case Report ◽

Organ Failure ◽

Inflammatory Mediators ◽

Polymyxin B ◽

Blood Purification ◽

Source Control ◽

Usual Therapy

The mortality of septic shock remains high [Ann Intensive Care. 2017;7:19], so apart from usual therapy based on source control and antibiotics, some patients may need rescue therapies. Blood purification systems may play a role by facilitating the nonspecific removal of inflammatory mediators and microbiological toxins. There are different hemoadsorption systems, we describe in this case report the sequential use of Polymyxin B (PMX) endotoxin-adsorbing column (Toraymixin PMX-20R; Toray, Tokyo, Japan) and Cytosorb® (Cytosorbents Corp., New Jersey, USA).

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Low-Dose Steroids Cut Mortality in Septic Shock

Family Practice News ◽

10.1016/s0300-7073(06)73943-3 ◽

2006 ◽

Vol 36 (19) ◽

pp. 24

Author(s):

BRUCE JANCIN

Keyword(s):

Septic Shock ◽

Low Dose

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Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

Bangladesh Journal of Urology ◽

10.3329/bju.v20i2.49654 ◽

2020 ◽

Vol 20 (2) ◽

pp. 61-64

Author(s):

Mohammad Mahfuzur Rahman Chowdhury ◽

Rifat Zaman ◽

Md Amanur Rasul ◽

Akm Shahadat Hossain ◽

Shafiqul Alam Chowdhury ◽

...

Keyword(s):

Renal Function ◽

Low Dose ◽

Ureteropelvic Junction Obstruction ◽

Percutaneous Nephrostomy ◽

Ureteropelvic Junction ◽

College Hospital ◽

Medical College ◽

Split Renal Function

Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

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