The importance of intravenous immunoglobulin treatment in critically ill patients with necrotizing soft tissue infection: a retrospective cohort study

BMC Infectious Diseases

Manuel R. Blum¹  Pascal M. Frey¹  Silvio D. Brugger²  Annelies S. Zinkernagel²  Daniel A. Hofmaenner³  Pedro David Wendel Garcia³  Sascha David³  Philipp K. Buehler³  Reto A. Schuepbach³ 

[1] Department of General Internal Medicine, Bern University Hospital (Inselspital), University of Bern;Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich;Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich;

关键词: Necrotizing soft tissue infections;    Intravenous immunoglobulins;    Decision making;    Combination therapy;   

DOI  :  10.1186/s12879-022-07135-6

来源: DOAJ

【 摘 要 】

Abstract Background Necrotizing soft-tissue infections are infections with high mortality. The use of immunoglobulins within a combination therapy including broad-spectrum antibiotics has been debated. We assessed potential benefits of immunoglobulins and hypothesized that they were associated with a treatment benefit in a high-resource setting. Methods Patients with necrotizing soft-tissue infection hospitalized in the tertiary intensive care unit of the University Hospital of Zurich, Switzerland, between 2008 and 2020 were included retrospectively. The association between immunoglobulin administration and in-hospital survival, intensive care unit length of stay, the incidences of acute renal failure, acute respiratory distress syndrome and septic shock were analyzed. Results After adjustment for confounders, no difference for in-hospital survival (hazard ratio 2.20, 95% confidence interval [CI] 0.24–20.20, p = 0.5), intensive care unit length of stay (subhazard ratio [SHR] 0.90, CI 0.41–1.98, p = 0.8) and the development of acute respiratory distress syndrome (SHR 1.2, CI 0.36–4.03, p = 0.77) was observed in patients with or without immunoglobulin treatment. The Simplified Acute Physiology Score II, the risk of developing acute renal failure (SHR 2.86, CI 1.33–6.15, p = 0.01) and septic shock (SHR 1.86, CI 1.02–3.40, p = 0.04) was higher in patients treated with immunoglobulins, possibly reflecting a higher disease severity beyond measured confounders. Conclusions No clear evidence for a benefit of immunoglobulins in our cohort with consistent antibiotic use was found. Patients receiving immunoglobulins appeared more severely ill. Complementary to high treatment standards and appropriate antibiotics including beta lactams and protein synthesis inhibitors, immunoglobulins should be administered on a case-to-case basis, at least while more evidence from larger randomized controlled trials is missing.

【 授权许可】

Unknown