title: Efficacy of endotoxin adsorption therapy (polymyxin B hemoperfusion) for methicillin-resistant Staphylococcus aureus toxic shock syndrome: a case report about five patients.
abstract: BACKGROUND
  Toxic shock syndrome (TSS), which can be life-threatening, is clinically and pathologically characterized by the presence of high fever, skin rash, desquamation, hypotension, and multiple organ failure caused by an enterotoxin produced by Staphylococcus aureus. In this study, we evaluated the effects of endotoxin adsorption therapy (polymyxin B [PMX] hemoperfusion) in critical patients with methicillin-resistant Staphylococcus aureus TSS (MRSA-TSS) who showed no improvement with the conventional therapy.
  
  
  METHODS
  Five MRSA-TSS patients (men/women: 3/2; median age: 39 years) who showed no improvement with the conventional therapy underwent PMX hemoperfusion in addition to the conventional therapy. The primary outcomes were change in the systolic arterial pressure (SAP) and requirement of a vasopressor after PMX hemoperfusion, and the secondary outcomes were change in laboratory data and sequential organ failure assessment (SOFA) scores 24 h after the therapy.
  
  
  RESULTS
  The median duration of PMX hemoperfusion was 9 h (range, 4-20 h). SAP significantly increased (from 89 to 125 mmHg, P<0.05) and the requirement of a vasopressor significantly decreased (from 10 to 2, P<0.05) after PMX hemoperfusion. Furthermore, the patients' white blood cell count decreased (from 17640 to 10090 /uL, P<0.05), and SOFA scores decreased (from 13 to 9, P<0.05) after PMX hemoperfusion. All patients recovered and were discharged from the ICU.
  
  
  CONCLUSIONS
  Our results showed that PMX hemoperfusion significantly improved the hemodynamics and severity in patients with life-threatening MRSA-TSS.
authors: Intensive Care Unit, Kanazawa University Hospital, Kanazawa, Japan. takutaniyan@yahoo.co.jp
authors: T
authors: T
authors: Taniguchi
authors: K
authors: K
authors: Sato
authors: A
authors: A
authors: Kurita
authors: T
authors: T
authors: Noda
authors: M
authors: M
authors: Okajima
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006464:Hemoperfusion; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B