Intravenous immunoglobulin for severe infections: a survey of Canadian specialists.
OBJECTIVE
To survey the opinions of Canadian critical care medicine and infectious disease specialists about the use of intravenous immunoglobulin (IVIG) for the treatment of severe infections.


METHODS
A scenario-based, cross-sectional survey of Canadian critical care medicine and infectious disease specialists was conducted from March to June 2003.


RESULTS
The response rate was 291/487 (60%). Respondents were primarily medically trained and most (241/291; 83%) were practicing in large academic referral centers. Physicians reported that they would use IVIG in patients with streptococcal toxic shock syndrome (STSS; 218/288; 76%), streptococcal necrotizing fasciitis without STSS (143/286; 50%), staphylococcal toxic shock syndrome (75/288; 26%), streptococcal soft tissue infection without NF or STSS (31/286; 11%), and septic shock due to intra-abdominal focus (9/283; 3%). The majority (> or =67%) of respondents believed that it would be ethical to randomize patients to IVIG or placebo in a clinical trial in each of the five scenarios. One third (192/286) reported that it would not be ethical to randomize patients with STSS. Canadian specialists commonly report favoring the use of IVIG to treat STSS and necrotizing fasciitis but less commonly endorse this treatment for other infections.


CONCLUSIONS
Specialist's beliefs surrounding the efficacy of IVIG would challenge but not preclude the conduct of future placebo controlled trials of severe streptococcal infections in Canada.
Laupland
Kevin B
KB
Department of Critical Care Medicine, University of Calgary, and Calgary Health Region, Calgary, Alberta, Canada. kevin.laupland@calgaryhealthregion.ca
Boucher
Paul
P
Rotstein
Coleman
C
Cook
Deborah J
DJ
Doig
Christopher J
CJ
D001291:Attitude of Health Personnel; D035061:Control Groups; D003422:Critical Care / Q000941:ethics / Q000379:methods*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004992:Ethics, Medical; D032984:Ethics, Research; D019115:Fasciitis, Necrotizing / Q000188:drug therapy; D019538:Health Care Surveys; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007239:Infections / Q000188:drug therapy*; D008511:Medicine / Q000379:methods*; D010919:Placebos; D016032:Randomized Controlled Trials as Topic / Q000941:ethics*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy; D018461:Soft Tissue Infections / Q000188:drug therapy; D013038:Specialization; D013203:Staphylococcal Infections / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy; D011795:Surveys and Questionnaires
D016756:Immunoglobulins, Intravenous; D010919:Placebos