[Hemoperfusion with polymyxin-B for the treatment of sepsis of abdominal origin by gram negative microorganisms]

López de Argumedo M, Galnares Cordero L
Record ID 32018000599
Original Title: Hemoperfusión con polimixina-B para el tratamiento de la sepsis de origen abdominal por microorganismos gram negativos
Authors' objectives: - Evaluate the clinical results provided by hemoperfusion with PMX-B added to conventional treatment in the treatment of sepsis of abdominal origin by Gram negativ emicroorganisms compared to usual treatment only. - Identify the factors that determine the effectiveness and safety of hemoperfusion with PMX-B added to conventional treatment. - To know the cost-effectiveness ratio of hemoperfusion with PMX-B added to treatment conventional in the treatment of sepsis.
Authors' results and conclusions: On effectiveness: one SR and two RCTs that provide favorable data in favor of the intervention have been analyzed in all the variables studied (mean arterial pressure at 72 hours, vasopressor drug dose, oxygen partial pressure / oxygen fraction inspired, mortality at 28 or 30 days). However these results are based on studies with important methodological limitations. About safety: information regarding adverse effects has been found related to this intervention in three studies included in the SR by Cruz et al. and in the EUPHAS study, which did not report severe adverse effects. Regarding the cost-effectiveness ratio: a study shows that this intervention is cost-effective for the treatment of patients in a situation of severe sepsis or septic shock due to infection of abdominal origin in Italy. This cost-effectiveness analysis is based on data of effectiveness of the EUPHAS study that presents important methodological limitations. According to this study, hemoperfusion with PMX-B together with the usual treatment, versus the usual treatment only, represents an expected average incremental cost of € 17,211; and an incremental cost-effectiveness ratio of € 3,864 per year of life won. Conclusions: While the data published to date is promising, the available evidence on hemoperfusion with PMX-B is inconclusive due to the methodological limitations of the studies, which prevents ruling out an overestimation of the effect of the intervention. Without However, as an exception to this general recommendation, its use could be considered in cases specific cases of severe sepsis for which there are no other effective alternative treatments.
Authors' methods: Systematic review of scientific literature published in English, German, Italian, French and Spanish.
Project Status: Completed
Year Published: 2013
English language abstract: There is no English language summary available
Publication Type: Rapid Review
Country: Spain
MeSH Terms
  • Sepsis
  • Abdomen
  • Intraabdominal Infections
  • Polymyxin B
  • Anti-Bacterial Agents
  • Drug Resistance, Multiple, Bacterial
  • Hemoperfusion
  • Sepsis
  • Hemoperfusion
  • Polymyxin B
  • Gram-Negative Bacterial Infections
  • Infecciones por Bacterias Gramnegativas
  • Polimixina B
  • Hemoperfusión
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.eus
Copyright: Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government
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