[Clinical investigation of extracorporeal endotoxin adsorption therapy in septic urinary tract infections].
OBJECTIVE
Severe urinary tract infection may lead to sepsis in some cases. In these cases, treatment must not only include drainage of the source of infection, but also management of systemic inflammatory response syndrome (SIRS). Blood purification therapy focused on endotoxin adsorption is thought to be a useful treatment method for this purpose. Herein, we clinically investigated the cases in which this treatment method was applied.


METHODS
A total of 22 patients underwent endotoxin adsorption therapy following diagnosis of sepsis at the department of urology, Hokkaido Social Welfare Association Furano Hospital during the last six years. Of these patients, six patients whose primary disease was urinary tract infection were included in the study.


RESULTS
Patients comprised four men and two women with either pyelonephritis (n = 5; complicated by prostatitis in one patient) or pyonephrosis (n = 1). Primary diseases included urolithiasis (n = 4), vesicoureteral reflux (n = 1), and ureteric stenosis (n = 1). Urinary tract drainage included ureteral stent (n = 4), nephrostomy (n = 1), and cystostomy (n = 1), with concomitant use of continuous hemodiafiltration in one patient. Serum endotoxin levels were 3.2 pg/ml on average, and returned to normal following endotoxin adsorption therapy in all patients. A total of four strains of Escherichia coli and one strain of Klebsiella pneumoniae were identified as pathogenic bacteria.


CONCLUSIONS
Hemodynamics was markedly stabilized following endotoxin adsorption therapy, and all patients survived. These findings indicate that endotoxin adsorption therapy should be actively considered as a treatment method for patients with sepsis secondary to urinary tract infection.
Department of Urology and Dialysis Center, Hokkaido Social Welfare Association Furano Hospital.
Jun-ichi
J
Hori
Satoshi
S
Yamaguchi
Masaki
M
Watanabe
Hiroaki
H
Osanai
Takuya
T
Kitase
Katsuhiko
K
Yonemura
Tokiko
T
Kakiuchi
Takahiro
T
Kinebuchi
D000368:Aged; D000369:Aged, 80 and over; D004731:Endotoxins / Q000302:isolation & purification*; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications*
D004731:Endotoxins