Hemoperfusion with Polymyxin B-Immobilized Fiber in Septic Patients with Methicillin-Resistant <i>Staphylococcus aureus</i>-Associated Glomerulonephritis

Abstract

Background/Aims: We investigated whether urinary podocytes are present in septic patients with methicillin-resistant Staphylococcus aureus (MRSA)-associated glomerulonephritis and whether polymyxin B-immobilized fiber (PMX-F) treatment affects proteinuria and urinary podocyte excretion in these patients. Methods: Twenty septic patients with MRSA-associated glomerulonephritis (mean age: 63.7 years) and 80 septic patients whose MRSA infection was not followed by glomerulonephritis (mean age: 60.5 years) were included in this study. All septic patients were treated with fosfomycin sodium, β-lactams, arbekacin sulfate, and teicoplanin, or a combination of these. Twenty septic patients with MRSA-associated glomerulonephritis were randomly assigned to one of two treatments: PMX-F treatment (group A, n = 10) and conventional treatment (group B, n = 10). PMX-F treatment was repeated twice. Results: Urinary podocytes and urinary protein excretion were not detected in MRSA septic patients without glomerulonephritis. However, urinary podocytes (1.7 ± 0.6 cells/ml) and proteinuria (2.6 ± 0.6 g/d) were detected in the 20 septic patients with MRSA-associated glomerulonephritis. Plasma endotoxin levels were decreased from 13.6 ± 4.6 pg/ml to 6.6 ± 2.2 pg/ml (p < 0.05) in group A. Levels in group B, however, showed little difference after treatment. Urinary podocytes were reduced in group A (from 1.8 ± 0.6 cells/ml to 0.4 ± 0.2 cells/ml, p < 0.01) as was urinary protein excretion (from 3.0 ± 0.5 g/d to 0.8 ± 0.4 g/d, p < 0.01) but urinary podocytes and protein excretion levels showed little difference after treatment in group B. Conclusion: PMX-F treatment may be effective in reducing urinary protein and urinary podocyte excretion in septic patients with MRSA-associated glomerulonephritis.

Blood Purification and Mortality in Sepsis

“…Since selection of antibiotics is at least partially influenced by treating center, it is reasonable to hypothesize variable effects of blood purification across centers, all other factors aside. Similarly, our results suggest that the main drivers for the beneficial effects of blood purification in this analysis come from studies of hemoperfusion with PMX-B, and were performed in a single country (29,30,31,33,34,36). Although the overall effects of blood purification without PMX-B were consistent with PMX-B studies ( p = 0.15; I 2 = 27%) the effect size is considerably smaller (RR 0.89 vs. 0.57) and fails to reach statistical significance.…”

“…These trials were reported between 1999 and 2010. The Country of origin in six studies is Japan (29,30,31,33,34,36), all of which reported on hemoperfusion (Table 1, Table 2). The mean age of the study participants ranged from 33 to 75 years; 637 (77%) patients were admitted to the ICU (17,24–29,31–33,35); and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 24.2 (9,17,23,24,27–36).…”

“…However, other modalities such as hemoperfusion and plasma exchange are now being examined more closely. For example, hemoperfusion with a Polymyxin B fiber column appears to improve survival compared with conventional treatment (24,29,30,33,34,36). Trials included in this meta-analysis varied in terms of blood purification modality, and reflected the diversity of clinical practice informing trial methodology.…”

Changes in Serum S100A12 and sRAGE Associated with Improvement of the PaO₂/FiO₂ Ratio following PMX-DHP Therapy for Postoperative Septic Shock

“…There is also a report that PMX-DHP improves the pathology of other types of sepsis besides the sepsis caused by Gram-negative bacteria [29]. However, in order to draw any conclusions about this, sepsis due to Gram-negative mixed infections would need to be completely excluded.…”

Endotoxin Filtration in Gram-negative Sepsis

“…[26][27][28][29][30][31][32][33][34][35] Table 1 summarizes the main studies on the use of Polymyxin B hemoperfusion. [26][27][28][29][30][31][32][33][34][35] Table 1 summarizes the main studies on the use of Polymyxin B hemoperfusion.…”