USE OF INTRAVENOUS IMMUNOGLOBULIN (IVIG) THERAPY FOR HOSPITALIZED PATIENTS WITH ACUTE RESPIRATORY INFECTIONS

Abstract

Introduction Indications for Intravenous Immunoglobulin (IVIG) in the acute treatment of infections are limited. The aim of this study is to evaluate the use of IVIG in treating hospitalized patients with severe respiratory infections. Methods This study is a double-center, retrospective chart review of all hospitalized patients who received IVIG therapy for respiratory infections between 2011 and 2016. Age, gender, immune status, microbiological data, chest imaging, IVIG dosage, concomitant antimicrobial use, length of hospital stay, and required ICU stay were collected. Physician notes were reviewed to determine the outcomes of treatment. Results We found a total of 80 patients and 99 hospital admissions. RSV was identified in 41.4% of the cases, rhinovirus in 23.2%, parainfluenza in 18.2%, and metapneumovirus in 17.2%. 94% of the patients had a secondary immunodeficiency most commonly due to solid organ transplants, bone marrow transplants, or chemotherapy. 4% had a primary immunodeficiency, and 2% were not immunodeficient. The average dose of IVIG received was 514 mg/kg and the average length of stay was 11.7 days. Clinical improvement was noted in 82.8% of patients. 9.1% developed superinfections that needed additional antibiotic coverage, 3.0% were readmitted for additional doses of IVIG, 4.1% died from complications and only 1.0% developed toxicities such as increased LFTs. Conclusions This is the largest case series exploring the use and outcomes of IVIG therapy for severe viral respiratory infections. This data will serve as a cornerstone for future evaluation of the effectiveness of IVIG in respiratory infections, both in retrospective and prospective controlled studies.