title: Readministration of drotrecogin alfa (activated) in an adult with severe sepsis.
abstract: OBJECTIVE
  The case of a patient with severe, multidrug-resistant, postoperative sepsis who was successfully treated with drotrecogin alfa (activated) on two occasions is reported.
  
  
  CONCLUSIONS
  After a thigh debridement procedure, a 55-year-old African-American woman developed systemic inflammatory response syndrome (SIRS) secondary to necrotizing fasciitis. Despite empiric treatment including piperacillin-tazobactam and vancomycin, the patient remained severely hemodynamically unstable, exhibiting signs of multiorgan failure and requiring mechanical ventilation and the placement of a tracheostomy tube. After the administration of i.v. drotrecogin alfa (activated) 160 mg (24 μg/kg/hr) over 96 hours in combination with standard i.v. antimicrobials and vasopressin, the patient's hemodynamic status improved considerably. About three weeks later, the patient again developed SIRS that was refractory to standard therapies. After the results of laboratory cultures indicated ventilator-associated pneumonia due to multidrug-resistant Klebsiella pneumoniae, the woman received a second course of drotrecogin alfa and other therapies. Her condition improved and she was extubated and eventually transferred to a medical-surgical unit for continued care. While drotrecogin alfa, a recombinant form of human activated protein C (APC), has been shown to reduce mortality in adults with severe sepsis and acute organ dysfunction, previous reports indicated an increased risk of thrombotic events with the use of the drug, and there is speculation that the development of anti-APC antibodies might result in a diminished therapeutic response. In the case described here, there were no thrombotic events during or after either drotrecogin alfa infusion and no clinical evidence of antibody formation.
  
  
  CONCLUSIONS
  A patient received two complete courses of drotrecogin alfa (activated) without any treatment-related complications.
authors: Division of Pharmacotherapy, New York University Langone Medical Center, New York 10016, USA. marco.scipione@nyumc.org
authors: Marco R
authors: MR
authors: Scipione
authors: Boris
authors: B
authors: Nogid
authors: Evangelia
authors: E
authors: Davanos
authors: Robert V
authors: RV
authors: DiGregorio
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019115:Fasciitis, Necrotizing / Q000150:complications; D005260:Female; D006801:Humans; D008875:Middle Aged; D011486:Protein C / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated