| Title |
Successful treatments with polymyxin B hemoperfusion and recombinant human thrombomodulin for fulminant Clostridium difficile-associated colitis with septic shock and disseminated intravascular coagulation: a case report
|
|---|---|
| Published in |
Surgical Case Reports, July 2016
|
| DOI | 10.1186/s40792-016-0199-5 |
| Pubmed ID | |
| Authors |
Kazuhito Minami, Yoshihisa Sakaguchi, Daisuke Yoshida, Manabu Yamamoto, Masahiko Ikebe, Masaru Morita, Yasushi Toh |
| Abstract |
Clostridium difficile (CD)-associated colitis (CDAC) is endemic and a common nosocomial enteric disease encountered by surgeons in modern hospitals due to prophylactic or therapeutic antibiotic therapies. Currently, the incidence of fulminant CDAC, which readily causes septic shock followed by multiple organ dysfunction syndromes, is increasing. Fulminant CDAC requires surgeons to perform a prompt surgery, such as subtotal colectomy, to remove the septic source. It is known that fulminant CDAC is caused by the shift from an inflammatory response at a local mucosal level to a general systemic inflammatory reaction in which CD toxin-induced mediators' cascades disseminate. Recently, it has been proven that polymyxin B hemoperfusion (PMX-HP) improves septic shock and recombinant human thrombomodulin (rhTM) controls disseminated intravascular coagulation (DIC). In addition, clinically and basically, it has been shown that these treatments can control serous chemical mediators. Therefore, it is considered that these treatments are promising ones for patients with fulminant CDAC. In the current report, we present that these treatments without surgery contributed to the improvement of sepsis due to fulminant CDAC. We encountered a case who developed fulminant CDAC with septic shock and DIC after laparoscopic gastrectomy for gastric cancer. At admission to the intensive care unit, his APACHE II score was 22, which indicated an estimated risk of hospital death of 42.4 %. Our therapies were not the subtotal colectomy to remove septic sources but the combination treatments with both PMX-HP and rhTM. These combination therapies resulted in excellent outcomes, namely the dramatic improvement of septic shock and DIC and the patient's survival. We speculate that these combination therapies completely inhibit the CD toxin-induced mediators' cascades and correspond to the removal of septic sources. We recommend both PMX-HP and rhTM for patients who develop fulminant CDAC with septic shock and DIC to increase the survival benefit and replace the need for surgical treatment. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 10 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 10 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Librarian | 1 | 10% |
| Other | 1 | 10% |
| Student > Doctoral Student | 1 | 10% |
| Professor | 1 | 10% |
| Student > Ph. D. Student | 1 | 10% |
| Other | 1 | 10% |
| Unknown | 4 | 40% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 3 | 30% |
| Computer Science | 1 | 10% |
| Nursing and Health Professions | 1 | 10% |
| Physics and Astronomy | 1 | 10% |
| Immunology and Microbiology | 1 | 10% |
| Other | 0 | 0% |
| Unknown | 3 | 30% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 July 2016.
All research outputs
#20,336,685
of 22,881,964 outputs
Outputs from Surgical Case Reports
#239
of 488 outputs
Outputs of similar age
#320,219
of 365,664 outputs
Outputs of similar age from Surgical Case Reports
#9
of 19 outputs
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