title: Clinical efficacy of polyspecific intravenous immunoglobulin therapy in patients with streptococcal toxic shock syndrome: a comparative observational study.
abstract: BACKGROUND
  Streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis are the 2 most severe invasive manifestations caused by group A Streptococcus (GAS). Intravenous immunoglobulin (IVIG) therapy has been suggested as adjunctive treatment with a beneficial effect on mortality. However the clinical evidence is limited. Here we aim to further document the clinical efficacy of administered IVIG therapy in a comparative observational study of well-defined patients with STSS.
  
  
  METHODS
  The effect of IVIG was evaluated in patients with STSS prospectively identified in a nationwide Swedish surveillance study conducted between April 2002 and December 2004. Detailed data on symptoms, severity of disease, treatment, and outcome were obtained from 67 patients. Crude and adjusted analyses with logistic regression were performed.
  
  
  RESULTS
  Twenty-three patients received IVIG therapy compared with 44 who did not. No significant difference in comorbidities, severity of disease, organ failures, or sex was seen, but the IVIG group was slightly younger and had a higher degree of necrotizing fasciitis (56% vs 14%). The primary endpoint was 28-day survival. Adjusted analysis revealed that factors influencing survival in STSS were Simplified Acute Physiology Score II (odds ratio [OR], 1.1; P = .007), clindamycin (OR, 8.6; P = .007), and IVIG (OR, 5.6; P = .030).
  
  
  CONCLUSIONS
  This comparative observational study of prospectively identified STSS patients demonstrates that both IVIG and clindamycin therapy contribute to a significantly improved survival in STSS.
authors.affiliation: Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm.
authors.forename: Anna
authors.initials: A
authors.lastname: Linnér
authors.affiliation: Public Health Agency of Sweden, Solna.
authors.forename: Jessica
authors.initials: J
authors.lastname: Darenberg
authors.affiliation: Department of Infectious Diseases, Uppsala University.
authors.forename: Jan
authors.initials: J
authors.lastname: Sjölin
authors.affiliation: Public Health Agency of Sweden, Solna Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm Karolinska University Hospital, Solna, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Henriques-Normark
authors.affiliation: Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Stockholm.
authors.forename: Anna
authors.initials: A
authors.lastname: Norrby-Teglund
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D013297:Streptococcus pyogenes / Q000145:classification / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous; D002981:Clindamycin
keywords: Streptococcus pyogenes; clindamycin; necrotizing fasciitis; polyspecific intravenous immunoglobulin; streptococcal toxic shock syndrome