PDF(Pubmed)
Abstract：
BACKGROUND: Intravenous immunoglobulin (IVIg) for Clostridioides difficile infection (CDI) no longer features in treatment guidelines. However, IVIg is still used by some clinicians for severe or recurrent CDI (rCDI) cases. The main objective of this study was to investigate the efficacy of IVIg and to identify possible predictors of disease resolution post IVIg administration for patients with CDI.
METHODS: This retrospective observational cohort study of patients ≥2 years old hospitalised with severe, relapsing, or rCDI treated with IVIg therapy was performed in a large UK tertiary hospital between April 2018 and March 2023. Scanned electronic notes from patient admissions and clinical reporting systems were used to collect relevant data.
RESULTS: In total, 20/978 patients diagnosed with CDI over the 5-year study were treated with IVIg. Twelve (60%) had hospital-onset CDI. Eleven of the twenty patients (55%) responded to treatment, with a mean of 8.6 (SD 10.7) days to disease resolution. Sixteen (80%) patients were treated for severe CDI and four (20%) for rCDI (n = 3) and relapsing CDI (n = 1). There were no statistically significant differences in possible independent predictors of disease resolution post IVIg administration between groups. There was an average of 6.2 (4.9) days to IVIg administration after diagnosis with no difference between responders and non-responders (p = 0.88) and no further significant difference in additional indicators. Four (36%) of the responders were immunosuppressed compared to just one (11%) of the non-responders (p = 0.15). Six of the responders (two with recurrent and four with severe CDI) improved rapidly within 2 days, and three of these were immunosuppressed.
CONCLUSIONS: We observed disease resolution post IVIg therapy in over 50% of patients with refractory CDI. Our data also support a potential enhanced effect of IVIg in immunosuppressed individuals. Thus, the role of IVIg for CDI treatment, particularly in the immunosuppressed, warrants future case-control studies coupled to mechanistic investigations to improve care for this ongoing significant healthcare-associated infection.
METHODS: This retrospective observational cohort study of patients ≥2 years old hospitalised with severe, relapsing, or rCDI treated with IVIg therapy was performed in a large UK tertiary hospital between April 2018 and March 2023. Scanned electronic notes from patient admissions and clinical reporting systems were used to collect relevant data.
RESULTS: In total, 20/978 patients diagnosed with CDI over the 5-year study were treated with IVIg. Twelve (60%) had hospital-onset CDI. Eleven of the twenty patients (55%) responded to treatment, with a mean of 8.6 (SD 10.7) days to disease resolution. Sixteen (80%) patients were treated for severe CDI and four (20%) for rCDI (n = 3) and relapsing CDI (n = 1). There were no statistically significant differences in possible independent predictors of disease resolution post IVIg administration between groups. There was an average of 6.2 (4.9) days to IVIg administration after diagnosis with no difference between responders and non-responders (p = 0.88) and no further significant difference in additional indicators. Four (36%) of the responders were immunosuppressed compared to just one (11%) of the non-responders (p = 0.15). Six of the responders (two with recurrent and four with severe CDI) improved rapidly within 2 days, and three of these were immunosuppressed.
CONCLUSIONS: We observed disease resolution post IVIg therapy in over 50% of patients with refractory CDI. Our data also support a potential enhanced effect of IVIg in immunosuppressed individuals. Thus, the role of IVIg for CDI treatment, particularly in the immunosuppressed, warrants future case-control studies coupled to mechanistic investigations to improve care for this ongoing significant healthcare-associated infection.
摘要：
背景：艰难梭菌感染（CDI）的静脉免疫球蛋白（IVIg）不再是治疗指南中的特征。然而,IVIg仍然被一些临床医生用于严重或复发性CDI(rCDI)病例。这项研究的主要目的是研究IVIg的功效，并确定CDI患者在IVIg给药后疾病消退的可能预测因子。
方法：这项回顾性观察性队列研究对≥2岁的重症住院患者进行，复发，2018年4月至2023年3月,在英国一家大型三级医院进行了接受IVIg治疗的rCDI治疗.来自患者入院和临床报告系统的扫描电子笔记用于收集相关数据。
结果：总计，在5年的研究中诊断为CDI的20/978患者用IVIg治疗。12例（60％）有医院发作的CDI。20名患者中有11名(55%)对治疗有反应，疾病消退时间平均为8.6天（SD10.7）。16例（80％）患者接受了严重CDI治疗，4例（20％）接受了rCDI（n=3）和复发性CDI（n=1）治疗。两组间IVIg给药后疾病消退的可能独立预测因子没有统计学上的显著差异。诊断后给予IVIg平均6.2(4.9)天,应答者和非应答者之间没有差异(p=0.88),并且在其他指标中没有进一步的显著差异。与仅一个(11%)非应答者(p=0.15)相比,四个(36%)应答者被免疫抑制。6名反应者（2名复发，4名严重CDI）在2天内迅速改善，其中三个是免疫抑制的。
结论：我们在超过50%的难治性CDI患者中观察到IVIg治疗后疾病消退。我们的数据还支持IVIg在免疫抑制个体中的潜在增强作用。因此，IVIg在CDI治疗中的作用，特别是在免疫抑制中，未来的病例对照研究与机械研究相结合，以改善对这种持续的重大医疗保健相关感染的护理。
方法：这项回顾性观察性队列研究对≥2岁的重症住院患者进行，复发，2018年4月至2023年3月,在英国一家大型三级医院进行了接受IVIg治疗的rCDI治疗.来自患者入院和临床报告系统的扫描电子笔记用于收集相关数据。
结果：总计，在5年的研究中诊断为CDI的20/978患者用IVIg治疗。12例（60％）有医院发作的CDI。20名患者中有11名(55%)对治疗有反应，疾病消退时间平均为8.6天（SD10.7）。16例（80％）患者接受了严重CDI治疗，4例（20％）接受了rCDI（n=3）和复发性CDI（n=1）治疗。两组间IVIg给药后疾病消退的可能独立预测因子没有统计学上的显著差异。诊断后给予IVIg平均6.2(4.9)天,应答者和非应答者之间没有差异(p=0.88),并且在其他指标中没有进一步的显著差异。与仅一个(11%)非应答者(p=0.15)相比,四个(36%)应答者被免疫抑制。6名反应者（2名复发，4名严重CDI）在2天内迅速改善，其中三个是免疫抑制的。
结论：我们在超过50%的难治性CDI患者中观察到IVIg治疗后疾病消退。我们的数据还支持IVIg在免疫抑制个体中的潜在增强作用。因此，IVIg在CDI治疗中的作用，特别是在免疫抑制中，未来的病例对照研究与机械研究相结合，以改善对这种持续的重大医疗保健相关感染的护理。
