Clinical outcomes of intravenous immune globulin in severe clostridium difficile-associated diarrhea.
OBJECTIVE
Our objective was to determine if use of intravenous immune globulin (IVIG) decreases the incidence of mortality, colectomies, and length of stay in the hospital in patients presenting with severe Clostridium difficile-associated diarrhea (CDAD).


METHODS
A retrospective analysis was undertaken of 79 patients who had a positive C. difficile toxin titer and severe disease admitted to the University of Pittsburgh Medical Center Presbyterian between July 2001 and July 2003. Standard therapy for severe CDAD including intravenous metronidazole, oral vancomycin, or vancomycin enema was administered to all patients. Eighteen patients also received IVIG treatment (200-300 mg/kg); these were pair matched by propensity scoring with 18 patients who had the most similar characteristics and severity of CDAD from the available pool of 61 subjects who did not receive IVIG treatment.


RESULTS
No significant difference was observed in the baseline characteristics between the two groups. There were no statistical differences in clinical outcomes as measured by all cause mortality, colectomies, and length of stay.


CONCLUSIONS
These data demonstrate that the use of IVIG in severe CDAD remains unsubstantiated. This study, although limited by a small sample size, does not support the use of IVIG at this dose for severe CDAD outside of a controlled trial.
Juang
Paul
P
Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, 200 lothrop Street, Pittsburgh, PA 15213, USA. skledarsj@upmc.edu
Skledar
Susan J
SJ
Zgheib
Nathalie K
NK
Paterson
David L
DL
Vergis
Emanuel N
EN
Shannon
William D
WD
Ansani
Nicole T
NT
Branch
Robert A
RA
D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003082:Colectomy / Q000706:statistics & numerical data*; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors