Dwukrotne zastosowanie rekombinowanego aktywowanego białka C w leczeniu chorej z ciężką sepsą

*Grażyna Michalska-Krzanowska, Radosław Ratajski

Summary
Background.Drotrecogin alpha (activated, recombinant activated protein C) has been shown to reduce 28-day all-cause mortality in patients with severe sepsis and was approved for the treatment of adult patients. We describe a case of repeated administration of drotrecogin alpha in a single patient.
Case report. A 53-yr-old woman underwent elective cholecystectomy complicated by accidental biliary duct and colon perforation, subsequently developing sepsis with multiple organ failure. The patient received 24 mg/kg/h drotrecogin infusion for a total of 96 hours over 6 days (the infusion was interrupted twice because of surgical interventions). The patient´s condition improved and she was weaned from the ventilator after 3 days of drotrecogin infusion and transferred to a low dependency area.
After a further 3 weeks, the patient´s condition deteriorated because of bilateral pneumonia and ARDS. Drotrecogin alpha infusion was administered again, resulting in rapid improvement of respiratory function which allowed for extubation. Most unfortunately, 5 days later, her general condition worsened and she died during re-laparotomy due to catecholamine-resistant septic shock, probably caused by unrecognised fungal infection.
Discussion. The case, as described, confirms the high effectiveness of drotrecogin alpha in the treatment of severe sepsis and suggests that, in selected cases, repeated administration of the drug may be indicated. The drug itself could not however, reverse the course of disease when the source of infection had not been eradicated.

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