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Suffredini DA, Cui X, Jaswal D, et al. Anthrax immune globulin improves hemodynamics and survival during B. anthracis toxin-induced shock in canines receiving titrated fluid and vasopressor support. Intensive Care Med Exp. 2017;5(1):48doi: 10.1186/s40635-017-0159-9.
Suffredini, D. A., Cui, X., Jaswal, D., Remy, K. E., Li, Y., Sun, J., Solomon, S. B., Fitz, Y., Moayeri, M., Leppla, S., & Eichacker, P. Q. (2017). Anthrax immune globulin improves hemodynamics and survival during B. anthracis toxin-induced shock in canines receiving titrated fluid and vasopressor support. Intensive care medicine experimental, 5(1), 48. https://doi.org/10.1186/s40635-017-0159-9
Suffredini, Dante A, et al. "Anthrax immune globulin improves hemodynamics and survival during B. anthracis toxin-induced shock in canines receiving titrated fluid and vasopressor support." Intensive care medicine experimental vol. 5,1 (2017): 48. doi: https://doi.org/10.1186/s40635-017-0159-9
Suffredini DA, Cui X, Jaswal D, Remy KE, Li Y, Sun J, Solomon SB, Fitz Y, Moayeri M, Leppla S, Eichacker PQ. Anthrax immune globulin improves hemodynamics and survival during B. anthracis toxin-induced shock in canines receiving titrated fluid and vasopressor support. Intensive Care Med Exp. 2017 Oct 23;5(1):48. doi: 10.1186/s40635-017-0159-9. PMID: 29058092; PMCID: PMC5651533.
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Intensive Care Med Exp. 2017 Oct 23;5(1):48. doi: 10.1186/s40635-017-0159-9.

Anthrax immune globulin improves hemodynamics and survival during B. anthracis toxin-induced shock in canines receiving titrated fluid and vasopressor support.

Intensive care medicine experimental

Dante A Suffredini, Xizhong Cui, Dharmvir Jaswal, Kenneth E Remy, Yan Li, Junfeng Sun, Steven B Solomon, Yvonne Fitz, Mahtab Moayeri, Stephen Leppla, Peter Q Eichacker

Affiliations

  1. Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bldg 10, Rm 2C145, Bethesda, MD, 20892, USA.
  2. Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA.
  3. National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, 20892, USA.
  4. Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bldg 10, Rm 2C145, Bethesda, MD, 20892, USA. [email protected].

PMID: 29058092 PMCID: PMC5651533 DOI: 10.1186/s40635-017-0159-9

Abstract

BACKGROUND: Although anthrax immune globulin (AIG) improved survival in antibiotic-treated Bacillus anthracis-challenged animal models, whether it adds to the benefit of conventional hemodynamic support for B. anthracis toxin-associated shock is unknown.

METHODS: We therefore tested AIG in sedated, mechanically ventilated canines challenged with 24-h B. anthracis lethal and edema toxin infusions and supported for 96 h with a previously demonstrated protective regimen of titrated normal saline and norepinephrine.

RESULTS: Compared to controls, proportional survival (%) was increased with AIG treatment started 4 h before (33 vs. 100%, n = 6 each) or 2 h (17 vs. 86%, n = 6 and 7 respectively) or 5 h (0 vs. 67%, n = 3 each) after the start of toxin (p ≤ 0.05) and overall [3 survivors of 15 controls (20%) vs. 14 of 16 AIG animals (88%); p = 0.006]. Averaged across treatment times, AIG increased blood pressure at 48 h and decreased norepinephrine requirements at 72 h (p ≤ 0.02), increased left ventricular ejection fraction at 48 and 72 h (p ≤ 0.02), and increased urine output and decreased net fluid balance at 72 and 96 h (p ≤ 0.04). AIG also reduced acidosis and renal and hepatic injury markers between 24 and 96 h.

CONCLUSIONS: These findings further support AIG's potential benefit for patients with B. anthracis infection and developing toxin-associated shock.

Keywords: Anthrax immune globulin; Anthrax infection; B. anthracis; Edema toxin; Lethal toxin; Sepsis

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