Clinical Efficacy of Polyspecific Intravenous Immunoglobulin Therapy in Patients With Streptococcal Toxic Shock Syndrome: A Comparative Observational Study

• Published in: Clinical infectious diseases Vol. 59; no. 6; pp. 851 - 857
• Main Authors: Linnér, Anna, Darenberg, Jessica, Sjölin, Jan, Henriques-Normark, Birgitta, Norrby-Teglund, Anna
• Format: Journal Article
• Language: English
• Published: Oxford OXFORD UNIVERSITY PRESS 15.09.2014; Oxford University Press
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; ARTICLES AND COMMENTARIES; Bacterial diseases; Biological and medical sciences; clindamycin; Clindamycin - therapeutic use; Comorbidity; Comparative analysis; Emergency and intensive care: infection, septic shock; Female; Human bacterial diseases; Humans; Immunoglobulins; Immunoglobulins, Intravenous - therapeutic use; Infectious diseases; Intensive care medicine; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; necrotizing fasciitis; Odds Ratio; polyspecific intravenous immunoglobulin; Prognosis; Prospective Studies; Regression analysis; Shock, Septic - diagnosis; Shock, Septic - mortality; Shock, Septic - therapy; Staphylococcal infections, streptococcal infections, pneumococcal infections; Streptococcal Infections - diagnosis; Streptococcal Infections - microbiology; Streptococcal Infections - mortality; Streptococcal Infections - therapy; streptococcal toxic shock syndrome; Streptococcus infections; Streptococcus pyogenes; Streptococcus pyogenes - classification; Streptococcus pyogenes - genetics; Treatment Outcome; Infection; Human; Treatment; Intravenous administration; Immunotherapy; Streptococcal infection; Bacteriosis; Staphylococcal infection; Comparative study; Toxic shock syndrome; Streptococcus pyogenes; streptococcal toxic shock syndrome; clindamycin; polyspecific intravenous immunoglobulin; necrotizing fasciitis
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/ciu449

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.