Relationship between polyclonal immunoglobulin therapy and colonization by Candida spp.

Abstract

Introduction Low IgA levels in blood serum and in saliva have been associated with an increased risk for Candida colonization and infection [1,2]. In this retrospective cohort study, we aimed to evaluate the effects of an intravenous immunoglobulin preparation containing polyclonal IgG, IgM and IgA (IgGAM) on the prevention of Candida spp. colonization in patients with septic shock. Methods In this study we analyzed 69 patients with septic shock and without Candida spp. colonization before shock appearance admitted to the ICU of a university hospital from January 2008 to November 2011. All of the patients were treated in according to the Surviving Sepsis Campaign guidelines. In addition to standard therapy, 44 (64%) patients received IgGAM therapy (Pentaglobin® 38 g/l IgG, 6 g/l IgM, and 6 g/l IgA) within 24 hours from the diagnosis of septic shock at the dose of 250 mg/kg/day for 3 days. The colonization by Candida spp. was evaluated by analyzing the results of the microbiological surveillance cultures (two times per week) of pharyngeal swab, tracheal aspirate, urine and surgical drains between 48 hours and 21 days after the diagnosis of septic shock. Results In the IgGAM group, 11 patients (25%) developed Candida spp. colonization compared to nine patients (36%) of the control group. The Candida colonization index was similar in the two groups: 0.42 ± 0.16 in the IgGAM group and 0.45 in the control group. Conclusion The above data show a slight reduction of Candida spp. colonization in septic shock patients treated with IgGAM therapy. Further studies are needed to confirm this finding.