Polymyxin‐B immobilized column–direct hemoperfusion for adolescent toxic shock syndrome

Abstract

Toxic shock syndrome (TSS) is a critical illness associated with toxin from Staphylococcus aureus. Despite recent advances in critical care, mortality remains high and additional effective therapy is required. We report an adolescent case of TSS successfully treated with direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP). The patient with spina bifida also had ischial pressure ulcer, and developed TSS associated with methicillin-resistant S. aureus. Despite conventional treatment, the patient developed refractory shock, which was immediately improved with PMX-DHP. PMX-DHP has been widely used for the treatment of sepsis to remove circulating endotoxins produced by Gram-negative bacteria, but beneficial effects have also been reported for Gram-positive bacterial infection. To our knowledge, this is the first report on PMX-DHP for TSS in an adolescent patient, and we propose that PMX-DHP could be a new treatment strategy for severe TSS in children as well.

Clinical effects of polymyxin B‐immobilized fiber column direct hemoperfusion for severe bacterial meningitis: A series of 10 cases

“…Alternative treatment was urgently required to maintain life. On hospital day 3, we decided to perform PMX‐DHP to suppress the cytokine storm (Figure ; reprinted from Suzuki et al based on the reported effectiveness of PMX‐DHP for sepsis due to Gram‐positive bacteria . Immediately after the first PMX‐DHP session, he opened his eyes spontaneously and his consciousness level dramatically improved (Figure ).…”

“…Eight of our 10 patients were identified to have Gram‐positive bacteria, which do not have lipopolysaccharide. However, PMX fibers were reported to adsorb LTA, and PMX‐DHP is effective for septic shock due to Gram‐positive bacteria …”

“…The PMX‐DHP column is a medical device designed to reduce circulating endotoxin produced by Gram‐negative bacteria . Several reports, however, have also noted beneficial effects of PMX‐DHP for Gram‐positive bacterial infection . Clinical experience with PMX‐DHP for meningitis is limited though and has not been described in English‐language publications.…”

ECMO for Neonatal Sepsis in 2019

“…Adsorptive therapies have been utilized mostly for hyperinflammatory syndromes (hemophagocytic lymphohystiocitosis, macrophage activation syndrome) or toxin-mediated infections manifesting as SIRS/septic shock. Two clinical reports from Japan on non ECMO neonates with sepsis/toxic shock highlight the potential adoption of these techniques on ECMO (70,71). Similarly, non ECMO studies on adults with septic shock treated with HA330 adsorption cylinder showed improved hemodynamic parameters and decreased mortality (72).…”

Polymyxin B hemoperfusion in septic shock: nothing overmuch (Meden Agan)!

“…PMX-HP might also attenuate pro-apoptotic plasma activity on septic renal tubular cells (17). Beneficial effects concerning GPC infection have scarcely been reported while the PMX-HP treatment strategy for severe toxic shock syndrome in children has also been proposed (18).…”