Τίτλος:
Improving outcomes of severe infections by multidrug-resistant pathogens with polyclonal IgM-enriched immunoglobulins
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
The emergence of infections by multidrug-resistant (MDR) Gram-negative bacteria, which is accompanied by considerable mortality due to inappropriate therapy, led to the investigation of whether adjunctive treatment with one polyclonal IgM-enriched immunoglobulin preparation (IgGAM) would improve outcomes. One hundred patients in Greece with microbiologically confirmed severe infections by MDR Gram-negative bacteria acquired after admission to the Intensive Care Unit and treated with IgGAM were retrospectively analysed from a large prospective multicentre cohort. A similar number of patient comparators well-matched for stage of sepsis, source of infection, appropriateness of antimicrobials and co-morbidities coming from the same cohort were selected. All-cause 28-day mortality was the primary end point; mortality by extensively drug-resistant (XDR) pathogens and time to breakthrough bacteraemia were the secondary end points. Fifty-eight of the comparators and 39 of the IgGAM-treated cases died by day 28 (p 0.011). The OR for death under IgGAM treatment was 0.46 (95% CI 0.26–0.85). Stepwise regression analysis revealed that IgGAM was associated with favourable outcome whereas acute coagulopathy, cardiovascular failure, chronic obstructive pulmonary disease and chronic renal disease were associated with unfavourable outcome. Thirty-nine of 62 comparators (62.9%) were infected by XDR Gram-negative bacteria and died by day 28 compared with 25 of 65 cases treated with IgGAM (38.5%) (p 0.008). Median times to breakthrough bacteraemia were 4 days and 10 days, respectively (p <0.0001). Results favour the use of IgGAM as an adjunct to antimicrobial treatment for the management of septic shock caused by MDR Gram-negative bacteria. A prospective randomized trial is warranted. © 2016 The Authors
Συγγραφείς:
Giamarellos-Bourboulis, E.J.
Tziolos, N.
Routsi, C.
Katsenos, C.
Tsangaris, I.
Pneumatikos, I.
Vlachogiannis, G.
Theodorou, V.
Prekates, A.
Antypa, E.
Koulouras, V.
Kapravelos, N.
Gogos, C.
Antoniadou, E.
Mandragos, K.
Armaganidis, A.
Hellenic Sepsis Study Group
Περιοδικό:
Clinical Microbiology and Infection
Λέξεις-κλειδιά:
immunoglobulin M; immunoglobulin M; immunologic factor, adult; antibiotic resistance; antibiotic therapy; Article; blood clotting disorder; chronic kidney disease; chronic obstructive lung disease; comorbidity; controlled study; disease severity; female; Gram negative bacterium; heart failure; hospital admission; human; intensive care unit; major clinical study; male; middle aged; outcome assessment; priority journal; prospective study; retrospective study; septic shock; aged; clinical trial; Gram-Negative Bacterial Infections; Greece; microbiology; mortality; multicenter study; multidrug resistance; survival analysis; treatment outcome; very elderly, Adult; Aged; Aged, 80 and over; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacterial Infections; Greece; Humans; Immunoglobulin M; Immunologic Factors; Intensive Care Units; Male; Middle Aged; Prospective Studies; Retrospective Studies; Survival Analysis; Treatment Outcome
DOI:
10.1016/j.cmi.2016.01.021
