title: Prophylactic intravenous immune globulin and polymixin B decrease the incidence of septic episodes and hospital length of stay in severely burned children.
abstract: After burn shock resuscitation, serum gamma globulin levels decrease well below normal before slowly recovering over the course of 1 to 2 months. During this period, patients are vulnerable to further insult as a result of this immunocompromise. We hypothesized that intravenous immune globulin and subtherapeutic polymixin B (IVIG-B) could decrease the incidence and/or severity of sepsis after major thermal injury. A retrospective chart review from 1997 through 2003 at two hospitals compared patients who received IVIG-B (Hospital A) with those who did not (Hospital B). Patients with burns 40% or greater TBSA were included, whereas patients with nonsurvivable injuries were excluded from data analysis. A total of 152 patients were included in the study. One hundred two patients received IVIG-B, and 50 did not. Total burn size was 63.4% TBSA at Hospital A and 63.1% TBSA at Hospital B, with full-thickness burns of 54.4 and 61.7% TBSA, respectively (P < .05). Patients treated at Hospital A had a 51.9% incidence of inhalation injury compared with 28% of the patients at Hospital B (P < .05). There was an average of 1.2 and 1.9 septic episodes for patients treated at Hospital A and Hospital B, respectively (P < .05). Length of hospital stay was 77.1 days at Hospital A compared with 103.8 days at Hospital B (P < .05). Mortality was 17.6% and 18% at Hospitals A and B, respectively, and was not significantly different. Our data suggest that prophylactic IVIG-B is associated with a reduction in the incidence of septic episodes and decreased hospital length of stay following major thermal injury.
authors.affiliation: Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3095, USA.
authors.forename: Jefferson M
authors.initials: JM
authors.lastname: Lyons
authors.forename: Christopher
authors.initials: C
authors.lastname: Davis
authors.forename: Mary T
authors.initials: MT
authors.lastname: Rieman
authors.forename: Robert
authors.initials: R
authors.lastname: Kopcha
authors.forename: Ho
authors.initials: H
authors.lastname: Phan
authors.forename: David
authors.initials: D
authors.lastname: Greenhalgh
authors.forename: Tina
authors.initials: T
authors.lastname: Palmieri
authors.forename: Richard
authors.initials: R
authors.lastname: Kagan
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002056:Burns / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011112:Polymyxin B / Q000627:therapeutic use*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015208:Smoke Inhalation Injury / Q000453:epidemiology; D015599:Trauma Severity Indices
chemical_list: D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D011112:Polymyxin B