Intravenous non-specific immunoglobulins as adjunctive therapy for invasive Streptococcus pyogenes infection: an...

Adjunctive intravenous non-specific immunoglobulin (IVIG) is used in the management of streptococcal toxic shock syndrome, although supporting evidence remains limited. The primary objective of this study was to describe the use of IVIG in patients with invasive Streptococcus pyogenes infection.

We conducted a retrospective observational study over 11 years, including patients diagnosed with invasive S. pyogenes infection who received at least one dose of IVIG as adjunctive therapy.

Twenty-three patients were included, with a mean age of 63.2 ± 16.3 years; 47.8% were male. Most patients (73.9%) developed septic shock and STSS, requiring admission to intensive care units. The mean Sequential Organ Failure Assessment (SOFA) score was 9.1 ± 4.9. High-dose IVIG (2.0 ± 0.2 g/kg) was administered promptly, with a mean time to first infusion of 0.26 ± 0.47 days from admission. In-hospital mortality was 21.7% overall and 29.4% among STSS patients. Non-survivors had significantly higher disease severity and were more likely to develop hepatic dysfunction and require continuous renal replacement therapy (CRRT). Two patients (8.7%) experienced IVIG-related adverse events, both of which were mild.

Early and standardized high-dose IVIG administration, in combination with prompt targeted antibiotic therapy and intensive supportive care, was associated with mortality rates similar to, or lower than, those previously reported. Initial disease severity, hepatic dysfunction, and need for CRRT were identified as predictors of mortality. IVIG demonstrated a favorable safety profile.