title: Intravenous immunoglobulin for the treatment of severe Clostridium difficile colitis: an observational study and review of the literature.
abstract: BACKGROUND
  Clostridium difficile colitis (CDC) is the most common cause of hospital-acquired diarrhea. The increase in the incidence and fatality rate of CDC over the past decade has stimulated a search for new therapies, including intravenous immunoglobulin (IVIG). We report our experience with IVIG for the treatment of 21 patients with severe CDC.
  
  
  METHODS
  Retrospective review of patients with severe CDC who received IVIG between July 2002 and April 2006 at a teaching hospital. The existing literature on IVIG infusion for severe CDC was also reviewed.
  
  
  RESULTS
  Twenty-one of 1230 patients with CDC were treated with IVIG. The mean age was 68 (range, 35-98) years, with mean hospital stay of 23 (range, 9-64) days. Conventional treatment was used for an average of 8 (range, 1-25) days before IVIG infusion. All patients had evidence of pancolitis (radiologically) or ileus (clinically). The mean Acute Physiological Assessment and Chronic Health Evaluation (APACHE II) score was 25 (range, 6-39) at day 1 of IVIG infusion. Nine patients (43%) survived their hospitalization with colitis resolution while 12 (57%) died. One patient developed pulmonary edema after IVIG infusion. Symptoms resolved after an average of 10 (range, 2-20) days for survivors. Two patients underwent urgent colectomy.
  
  
  CONCLUSIONS
  This is the largest case series describing IVIG use for patients with severe CDC and the one with the highest mortality rate to date. The use of IVIG in this setting does not seem to benefit all patients. Benefit appears to depend on the extent of systemic involvement. Further studies are needed before adopting IVIG as routine treatment for severe CDC.
authors.affiliation: Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA. mabouge1@jhmi.edu
authors.forename: Marwan S
authors.initials: MS
authors.lastname: Abougergi
authors.forename: Apoorv
authors.initials: A
authors.lastname: Broor
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000187:drug effects*; D003092:Colitis / Q000188:drug therapy*; D003428:Cross Infection; D004305:Dose-Response Relationship, Drug; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019370:Observation; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D016756:Immunoglobulins, Intravenous