Pota Vincenzo, Passavanti Maria Beatrice, Sansone Pasquale, Pace Maria Caterina, Peluso Filomena, Fiorelli Alfonso, Aurilio Caterina
Department of Women, Infant and Surgical and Specialist Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.
Thoracic Surgery Unit, University of Campania "L. Vanvitelli", Naples, Italy.
J Med Case Rep. 2018 Mar 3;12(1):55. doi: 10.1186/s13256-018-1611-5.
Descending necrotizing mediastinitis is a common and progressive polymicrobial infection involving the neck and chest with a high death rate (10 to 40%). From a microbiological point of view, descending necrotizing mediastinitis is sustained by Gram-positive bacteria (43-62%), anaerobes (46-78%), and, rarely, Gram-negative bacteria. Data collected during the Antibiotic Resistance-Istituto Superiore di Sanità project confirmed that Italy is positioned among the countries with the highest levels of resistance in most pathogenic species under surveillance. In particular, 32.9% of Klebsiella pneumoniae isolates were resistant to carbapenem, 33.6% of Staphylococcus aureus to methicillin, and 28.7% and 43.9% of Escherichia coli isolates to third-generation cephalosporins and fluoroquinolones, respectively.
We describe the case of a 38-year-old white man with septic shock due to descending necrotizing mediastinitis sustained by multidrug-resistant Gram-negative and Gram-positive bacteria treated after surgery with an IgM-enriched immunoglobulin preparation and polymyxin B hemoperfusion therapy.
Despite the contrasting data on the use of immunoglobulins and polymyxin B hemoperfusion in septic shock and the lack of literature in cases of acute mediastinitis caused by both Gram-negative and Gram-positive multidrug-resistant bacteria, we obtained an improvement in clinical conditions and the survival of our patient, against all odds.
下行性坏死性纵隔炎是一种常见的进行性多微生物感染，累及颈部和胸部，死亡率高（10%至40%）。从微生物学角度来看，下行性坏死性纵隔炎由革兰氏阳性菌（43%-62%）、厌氧菌（46%-78%）引起，很少由革兰氏阴性菌引起。在“抗生素耐药性-国家高等卫生研究院”项目期间收集的数据证实，意大利在受监测的大多数致病物种中，处于耐药水平最高的国家之列。特别是，32.9%的肺炎克雷伯菌分离株对碳青霉烯耐药，33.6%的金黄色葡萄球菌对甲氧西林耐药，28.7%和43.9%的大肠埃希菌分离株分别对第三代头孢菌素和氟喹诺酮耐药。
我们描述了一名38岁白人男性的病例，他因下行性坏死性纵隔炎导致感染性休克，由多重耐药革兰氏阴性菌和革兰氏阳性菌引起，术后接受了富含IgM的免疫球蛋白制剂和多粘菌素B血液灌流治疗。
尽管关于免疫球蛋白和多粘菌素B血液灌流在感染性休克中的应用数据存在矛盾，且缺乏革兰氏阴性菌和革兰氏阳性菌多重耐药引起的急性纵隔炎病例的文献报道，但我们的患者在绝境中临床状况得到改善并存活了下来。
