title: Septic shock secondary to β-hemolytic streptococcus-induced necrotizing fasciitis treated with a novel cytokine adsorption therapy.
abstract: BACKGROUND
  Numerous animal studies and preliminary data from a clinical trial in septic patients demonstrated that a decrease in blood cytokine levels using an extracorporeal cytokine filter (CytoSorb) can effectively attenuate the inflammatory response during sepsis and possibly improve outcomes.
  
  
  METHODS
  A 60-year-old female was admitted to hospital due to a forearm fracture. After surgical wound care by osteosynthesis the patient developed surgical wound infection which progressed to necrotizing fasciitis. All diagnostic criteria for SIRS were evident with additional proven infection from β-hemolytic streptococcus. On admission to the ICU, the patient presented a full picture of multiple organ dysfunction syndrome due to septic shock including kidney failure, lung failure as well as thrombocytopenia, metabolic acidosis, and arterial hypotension.
  
  
  RESULTS
  After one day on mechanical ventilation and an IL-6 level of 70,000 pg/ml the patient was treated with CytoSorb therapy over a period of four days, resulting in a significant reduction of IL-6 to 66 pg/ml and an overall improvement of the patient's condition. Despite the necessity of enucleation, the patient was successfully stabilized until control of the surgical infectious source was achieved. Importantly, treatment was safe and well-tolerated, without any adverse events.
  
  
  CONCLUSIONS
  This is the first report of the clinical application of CytoSorb hemoadsorption in combination with a CRRT in a patient with septic shock. CytoSorb as described was able to significantly reduce IL-6 plasma levels and decrease vasopressor need while no adverse and device-related events occurred. CytoSorb seems to be an interesting and safe extracorporeal therapy to stabilize and bridge septic patients to surgery or recovery.
authors.affiliation: 1 AUVA Meidling Emergency Hospital, Department of Anesthesiology and Intensive Care Medicine, Vienna - Austria.
authors.forename: Hubert
authors.initials: H
authors.lastname: Hetz
authors.forename: Reinhard
authors.initials: R
authors.lastname: Berger
authors.forename: Peter
authors.initials: P
authors.lastname: Recknagel
authors.forename: Heinz
authors.initials: H
authors.lastname: Steltzer
mesh_terms: D000327:Adsorption; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology*; D013290:Streptococcal Infections / Q000150:complications* / Q000188:drug therapy; D013291:Streptococcus; D013530:Surgical Wound Infection / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents