Use of drotrecogin alfa (activated) in two patients with severe sepsis.
BACKGROUND
Severe sepsis is a disease associated with high mortality rates, which may be related to late diagnosis and institution of treatment, as well as unsatisfactory effectiveness of therapies used so far. Frequent monitoring of the patient's clinical condition and laboratory results for early signs of sepsis and use of recombinant activated protein C can improve significantly the outcome of treatment.


METHODS
The paper presents two patients with severe sepsis treated with drotrecogin alfa (activated). The first one, after multiorgan trauma, with renal failure due to crush injury, started to manifest gradually progressing symptoms of severe sepsis on 9th day of hospitalization in ICU. On 18th day, developing septic shock was diagnosed. As the initial standard therapy proved ineffective, it was decided to start recombinant human activated protein C (rhAPC). During infusion of the drug, dynamic improvement of organ function (respiratory and circulatory system, kidneys) and general condition of the patient was observed. The second patient, with rapidly progressing symptoms of septic shock and liver abscess confirmed as the source of infection, was subjected to therapy with Xigris (Eli Lilly, USA) on the 2nd day of treatment in ICU, 12 hours after abscess drainage and compensation of blood platelet deficiency. This case also demonstrated rapid improvement of the patient's condition and function of the organs involved by the disease (rapid stabilization of blood platelet count is notable).


CONCLUSIONS
In both presented cases, the therapy with drotrecogin alfa (activated) was used due to lack of satisfactory response to initial standard treatment. Both cases indicate that the preparation is effective and safe.
Mikaszewska-Sokolewicz
Małgorzata
M
1st Department and Chair of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland. katedra@anest.pl
Nierebińska
Małorzata
M
Mayzner-Zawadzka
Ewa
E
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000188:drug therapy; D011486:Protein C / Q000627:therapeutic use*; D013902:Radiography, Thoracic; D011994:Recombinant Proteins / Q000627:therapeutic use*; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality
D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated