PMID- 28034881
OWN - NLM
STAT- MEDLINE
DCOM- 20171222
LR  - 20220316
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Print)
IS  - 1058-4838 (Linking)
VI  - 64
IP  - 7
DP  - 2017 Apr 1
TI  - Impact of Intravenous Immunoglobulin on Survival in Necrotizing Fasciitis With 
      Vasopressor-Dependent Shock: A Propensity Score-Matched Analysis From 130 US 
      Hospitals.
PG  - 877-885
LID - 10.1093/cid/ciw871 [doi]
AB  - BACKGROUND: Shock frequently complicates necrotizing fasciitis (NF) caused by 
      group A Streptococcus (GAS) or Staphylococcus aureus. Intravenous immunoglobulin 
      (IVIG) is sometimes administered for presumptive toxic shock syndrome (TSS), but 
      its frequency of use and efficacy are unclear. METHODS: Adult patients with NF 
      and vasopressor-dependent shock undergoing surgical debridement from 2010 to 2014 
      were identified at 130 US hospitals. IVIG cases were propensity-matched and 
      risk-adjusted. The primary outcome was in-hospital mortality and the secondary 
      outcome was median length of stay (LOS). RESULTS: Of 4127 cases of debrided NF 
      with shock at 121 centers, only 164 patients (4%) at 61 centers received IVIG. 
      IVIG subjects were younger with lower comorbidity indices, but higher illness 
      severity. Clindamycin and vasopressor intensity were higher among IVIG cases, as 
      was coding for TSS and GAS. In-hospital mortality did not differ between matched 
      IVIG and non-IVIG groups (crude mortality, 27.3% vs 23.6%; adjusted odds ratio, 
      1.00 [95% confidence interval, .55-1.83]; P = .99). Early IVIG (</=2 days) did not 
      alter this effect (P = .99). Among patients coded for TSS, GAS, and/or S. aureus, 
      IVIG use was still unusual (59/868 [6.8%]) and lacked benefit (P = .63). Median 
      LOS was similar between IVIG and non-IVIG groups (26 [13-49] vs 26 [11-43]; P = 
      .84). Positive predictive values for identifying true NF and debridement among 
      IVIG cases using our algorithms were 97% and 89%, respectively, based on records 
      review at 4 hospitals. CONCLUSIONS: Adjunctive IVIG was administered infrequently 
      in NF with shock and had no apparent impact on mortality or hospital LOS beyond 
      that achieved with debridement and antibiotics.
CI  - Published by Oxford University Press for the Infectious Diseases Society of 
      America 2016. This work is written by (a) US Government employee(s) and is in the 
      public domain in the US.
FAU - Kadri, Sameer S
AU  - Kadri SS
AD  - Critical Care Medicine Department, National Institutes of Health Clinical Center, 
      Bethesda, Maryland.
AD  - Division of Infectious Diseases, Massachusetts General Hospital, Boston.
FAU - Swihart, Bruce J
AU  - Swihart BJ
AD  - Biostatistics Research Branch, National Institute of Allergy and Infectious 
      Diseases, Bethesda, Maryland.
FAU - Bonne, Stephanie L
AU  - Bonne SL
AD  - Department of General Surgery, Barnes Jewish Hospital, St Louis, Missouri.
FAU - Hohmann, Samuel F
AU  - Hohmann SF
AD  - Vizient, and.
AD  - Department of Health Systems Management, Rush University, Chicago, Illinois.
FAU - Hennessy, Laura V
AU  - Hennessy LV
AD  - Department of Surgery, Harborview Medical Center, Seattle, Washington; and.
FAU - Louras, Peter
AU  - Louras P
AD  - Department of Surgery, Harborview Medical Center, Seattle, Washington; and.
FAU - Evans, Heather L
AU  - Evans HL
AD  - Department of Surgery, Harborview Medical Center, Seattle, Washington; and.
FAU - Rhee, Chanu
AU  - Rhee C
AD  - Department of Population Medicine, Harvard Medical School and Harvard Pilgrim 
      Health Care Institute, Boston, Massachusetts.
FAU - Suffredini, Anthony F
AU  - Suffredini AF
AD  - Critical Care Medicine Department, National Institutes of Health Clinical Center, 
      Bethesda, Maryland.
FAU - Hooper, David C
AU  - Hooper DC
AD  - Division of Infectious Diseases, Massachusetts General Hospital, Boston.
FAU - Follmann, Dean A
AU  - Follmann DA
AD  - Biostatistics Research Branch, National Institute of Allergy and Infectious 
      Diseases, Bethesda, Maryland.
FAU - Bulger, Eileen M
AU  - Bulger EM
AD  - Department of Surgery, Harborview Medical Center, Seattle, Washington; and.
FAU - Danner, Robert L
AU  - Danner RL
AD  - Critical Care Medicine Department, National Institutes of Health Clinical Center, 
      Bethesda, Maryland.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Comorbidity
MH  - Fasciitis, Necrotizing/*complications/diagnosis/*drug therapy/mortality
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Immunoglobulins, Intravenous/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Propensity Score
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Shock/*complications/diagnosis/*drug therapy/mortality
MH  - Shock, Septic/complications/drug therapy/mortality
MH  - Staphylococcus aureus
MH  - Streptococcus pyogenes
MH  - Treatment Outcome
MH  - United States
MH  - Young Adult
PMC - PMC5850528
OTO - NOTNLM
OT  - intravenous immunoglobulin
OT  - necrotizing fasciitis.
OT  - toxic shock
EDAT- 2016/12/31 06:00
MHDA- 2017/12/23 06:00
PMCR- 2018/04/01
CRDT- 2016/12/31 06:00
PHST- 2016/08/08 00:00 [received]
PHST- 2016/12/22 00:00 [accepted]
PHST- 2016/12/31 06:00 [pubmed]
PHST- 2017/12/23 06:00 [medline]
PHST- 2016/12/31 06:00 [entrez]
PHST- 2018/04/01 00:00 [pmc-release]
AID - ciw871 [pii]
AID - 10.1093/cid/ciw871 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2017 Apr 1;64(7):877-885. doi: 10.1093/cid/ciw871.