Use of intravenous immunoglobulin in severe<i>Clostridium difficile</i>-associated diarrhea

Shahani, Lokesh R; Koirala, Janak

doi:10.1080/21548331.2015.1071636

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…The authors concluded that IVIG should only be used as adjunct therapy until results from large, randomized controlled trials are available. Two small retrospective matched cohort studies were published that compared the clinical efficacy of the addition of IVIG to conventional CDI treatment [306, 307]. Neither of these studies found significant differences between the compared cohorts in the main clinical outcomes, although Shahani et al [306] noted that in their IVIG cohort, there were significantly older patients with more severe CDI than in the control group.…”

Section: Recommendations For the Management Of CDImentioning

confidence: 99%

“…Two small retrospective matched cohort studies were published that compared the clinical efficacy of the addition of IVIG to conventional CDI treatment [306, 307]. Neither of these studies found significant differences between the compared cohorts in the main clinical outcomes, although Shahani et al [306] noted that in their IVIG cohort, there were significantly older patients with more severe CDI than in the control group. It is reasonable to utilize IVIG therapy in patients diagnosed with hypogammaglobuminemia based on the confirmation of IgG levels below the normal laboratory range.…”

Section: Recommendations For the Management Of CDImentioning

confidence: 99%

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2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

et al. 2019

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In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.

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Section: Recommendations For the Management Of CDImentioning

confidence: 99%

Section: Recommendations For the Management Of CDImentioning

confidence: 99%

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

et al. 2019

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“…Another therapeutic approach to CDI has been the attempt to attenuate the effects of the toxins by application of intravenous immunoglobulin or specific antibodies (bezlotoxumab and actoxumab). While intravenous immunoglobulin has been employed in critically ill CDI patients with limited success [ 58 ], the antibodies have primarily shown a decrease in CDI recurrence rates but have not proven efficacious in the primary treatment of severe CDI.…”

Section: Treatmentmentioning

confidence: 99%

Sleeping with the enemy: Clostridium difficile infection in the intensive care unit

et al. 2017

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Over the last years, there was an increase in the number and severity of Clostridium difficile infections (CDI) in all medical settings, including the intensive care unit (ICU). The current prevalence of CDI among ICU patients is estimated at 0.4–4% and has severe impact on morbidity and mortality. An estimated 10–20% of patients are colonized with C. difficile without showing signs of infection and spores can be found throughout ICUs. It is not yet possible to predict whether and when colonization will become infection. Figuratively speaking, our patients are sleeping with the enemy and we do not know when this enemy awakens.Most patients developing CDI in the ICU show a mild to moderate disease course. Nevertheless, difficult-to-treat severe and complicated cases also occur. Treatment failure is particularly frequent in ICU patients due to comorbidities and the necessity of continued antibiotic treatment. This review will give an overview of current diagnostic, therapeutic, and prophylactic challenges and options with a special focus on the ICU patient.First, we focus on diagnosis and prognosis of disease severity. This includes inconsistencies in the definition of disease severity as well as diagnostic problems. Proceeding from there, we discuss that while at first glance the choice of first-line treatment for CDI in the ICU is a simple matter guided by international guidelines, there are a number of specific problems and inconsistencies. We cover treatment in severe CDI, the problem of early recognition of treatment failure, and possible concepts of intensifying treatment. In conclusion, we mention methods for CDI prevention in the ICU.

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“…Fidaxomicin has been used in ICU patients and has shown similar response and recurrence rates to general medicine patients in a retrospective study but with no clear advantage (41). Case series of the use of other agents such as intravenous immunoglobulins, tigecycline and fecal microbiota therapy (FMT) for severe disease have been reported but none have been studied rigorously and therefore no recommendation can be made for their routine use in patients with severe CDI (42)(43)(44).…”

Section: Treatment Of Severe Uncomplicated Clostridium Difficile Infementioning

confidence: 99%

Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection

Loo

Davis

Embil

et al. 2018

Official Journal of the Association of Medical Microbiology and

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Clostridium difficile is recognized as a major cause of infection in health care facilities, associated with substantial morbidity and mortality, prolonged length of hospital stay, and excess costs. The frequency and severity of CDI increased dramatically in North America and in many parts of Europe approximately 15 years ago, with the emergence of a hyper-virulent strain of C. difficile, designated based on various strain typing methods as either AMMI CANADA GUIDELINE

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Use of intravenous immunoglobulin in severeClostridium difficile-associated diarrhea

Abstract: Our data demonstrate that although the patients who received IVIG had significantly severe infection, there was no difference in the mortality rate. Prospective controlled studies are needed to assess the true benefit of IVIG in patient with severe Clostridium difficle infection.

Cited by 8 publications

References 23 publications

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

Sleeping with the enemy: Clostridium difficile infection in the intensive care unit

Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection

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