Intravenous Immunoglobulins in Severe Clostridium difficile Colitis

Abstract

PURPOSE: Severe septic shock associated with Clostridium Difficile (CD) colitis infection is associated with significant mortality. Current therapeutic options include antibiotics, colectomy and fecal transplantation. We studied the use of Intravenous Immunoglobulins (IVIG) in patients admitted to medical intensive care unit (MICU) with severe septic shock with CD colitis and multiorgan failure who were not surgical candidates due to high risk of surgery. METHODS: We studied all patients presenting to our MICU with septic shock from CD colitis between July 2010-April 2011. All these patients were admitted to MICU from ER and were on vasopressors Diagnosis of C diff was based on clinical history, abdominal imaging and stool toxin tests. RESULTS: Total of 21 patients met the criteria and were treated with IVIG, along with vancomycin, intravenous metronidazole and oral rifaximin. The average age was 82 y (61-94 y) with M: F: 10:11. Out of this 14 patients (66.66%) were intubated and 17 patients (80.95%) had acute renal insufficiency on admission to MICU. The median APACHE IV score was 118.7 with median predicted mortality of 83 %. In our series 10 patients died (47.6%) as compared to predicted 83% (p value 0.051) with median ICULOS 6 days as opposed to predicted ICULOS as 9 days. CONCLUSIONS: The use of IVIG along with the aggressive antibiotics significantly reduced the mortality and ICU length of stay in patients with septic shock secondary to CD colitis. CLINICAL IMPLICATIONS: Patients with septic shock due to CD colitis should be treated with combination of aggressive antibiotics and IVIG.