{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T06:14:31Z","timestamp":1793340871380,"version":"4.5.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"7","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background.<\/jats:title>\n                  <jats:p>Shock frequently complicates necrotizing fasciitis (NF) caused by group A Streptococcus (GAS) or Staphylococcus aureus. Intravenous immunoglobulin (IVIG) is sometimes administered for presumptive toxic shock syndrome (TSS), but its frequency of use and efficacy are unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods.<\/jats:title>\n                  <jats:p>Adult patients with NF and vasopressor-dependent shock undergoing surgical debridement from 2010 to 2014 were identified at 130 US hospitals. IVIG cases were propensity-matched and risk-adjusted. The primary outcome was in-hospital mortality and the secondary outcome was median length of stay (LOS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results.<\/jats:title>\n                  <jats:p>Of 4127 cases of debrided NF with shock at 121 centers, only 164 patients (4%) at 61 centers received IVIG. IVIG subjects were younger with lower comorbidity indices, but higher illness severity. Clindamycin and vasopressor intensity were higher among IVIG cases, as was coding for TSS and GAS. In-hospital mortality did not differ between matched IVIG and non-IVIG groups (crude mortality, 27.3% vs 23.6%; adjusted odds ratio, 1.00 [95% confidence interval, .55\u20131.83]; P = .99). Early IVIG (\u22642 days) did not alter this effect (P = .99). Among patients coded for TSS, GAS, and\/or S. aureus, IVIG use was still unusual (59\/868 [6.8%]) and lacked benefit (P = .63). Median LOS was similar between IVIG and non-IVIG groups (26 [13\u201349] vs 26 [11\u201343]; P = .84). Positive predictive values for identifying true NF and debridement among IVIG cases using our algorithms were 97% and 89%, respectively, based on records review at 4 hospitals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions.<\/jats:title>\n                  <jats:p>Adjunctive IVIG was administered infrequently in NF with shock and had no apparent impact on mortality or hospital LOS beyond that achieved with debridement and antibiotics.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciw871","type":"journal-article","created":{"date-parts":[[2016,12,23]],"date-time":"2016-12-23T21:44:03Z","timestamp":1482529443000},"page":"877-885","source":"Crossref","is-referenced-by-count":86,"title":["Impact of Intravenous Immunoglobulin on Survival in Necrotizing Fasciitis With Vasopressor-Dependent Shock: A Propensity Score\u2013Matched Analysis From 130 US Hospitals"],"prefix":"10.1093","volume":"64","author":[{"given":"Sameer S.","family":"Kadri","sequence":"first","affiliation":[{"name":"Critical Care Medicine Department, National Institutes of Health Clinical Center 1 , Bethesda, Maryland ;"},{"name":"Division of Infectious Diseases, Massachusetts General Hospital 2 , Boston ;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce J.","family":"Swihart","sequence":"additional","affiliation":[{"name":"Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases 3 , Bethesda, Maryland ;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Bonne","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Barnes Jewish Hospital 4 , St Louis, Missouri ;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel F.","family":"Hohmann","sequence":"additional","affiliation":[{"name":"Vizient 5 , and"},{"name":"Department of Health Systems Management, Rush University 6 , Chicago, Illinois ;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura V.","family":"Hennessy","sequence":"additional","affiliation":[{"name":"Department of Surgery, Harborview Medical Center 7 , Seattle, Washington ; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Louras","sequence":"additional","affiliation":[{"name":"Department of Surgery, Harborview Medical Center 7 , Seattle, Washington ; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather L.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Surgery, Harborview Medical Center 7 , Seattle, Washington ; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanu","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute 8 , Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony F.","family":"Suffredini","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Department, National Institutes of Health Clinical Center 1 , Bethesda, Maryland ;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Hooper","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Massachusetts General Hospital 2 , Boston ;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean A.","family":"Follmann","sequence":"additional","affiliation":[{"name":"Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases 3 , Bethesda, Maryland ;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen M.","family":"Bulger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Harborview Medical Center 7 , Seattle, Washington ; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Danner","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Department, National Institutes of Health Clinical Center 1 , Bethesda, Maryland ;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,12,29]]},"reference":[{"key":"2024111411403435300_CIT0001","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1056\/NEJMoa042683","article-title":"Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles","volume":"352","author":"Miller","year":"2005","journal-title":"N Engl J Med"},{"key":"2024111411403435300_CIT0002","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1097\/00000658-199505000-00013","article-title":"Determinants of mortality for necrotizing soft-tissue infections","volume":"221","author":"McHenry","year":"1995","journal-title":"Ann Surg"},{"key":"2024111411403435300_CIT0003","doi-asserted-by":"crossref","first-page":"S106","DOI":"10.1111\/j.1444-0903.2005.00984.x","article-title":"Recognition and management of Staphylococcus aureus toxin-mediated disease","volume":"35","author":"Murray","year":"2005","journal-title":"Intern Med J"},{"key":"2024111411403435300_CIT0004","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S1473-3099(09)70066-0","article-title":"Gram-positive toxic shock syndromes","volume":"9","author":"Lappin","year":"2009","journal-title":"Lancet Infect Dis"},{"key":"2024111411403435300_CIT0005","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1146\/annurev.micro.55.1.77","article-title":"Toxic shock syndrome and bacterial superantigens: an update","volume":"55","author":"McCormick","year":"2001","journal-title":"Annu Rev Microbiol"},{"key":"2024111411403435300_CIT0006","doi-asserted-by":"crossref","first-page":"251","DOI":"10.3109\/10408419009105728","article-title":"Staphylococcal and streptococcal pyrogenic toxins involved in toxic shock syndrome and related illnesses","volume":"17","author":"Bohach","year":"1990","journal-title":"Crit Rev Microbiol"},{"key":"2024111411403435300_CIT0007","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3201\/eid0103.950301","article-title":"Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment","volume":"1","author":"Stevens","year":"1995","journal-title":"Emerg Infect Dis"},{"key":"2024111411403435300_CIT0008","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/S0002-9343(97)00160-5","article-title":"Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. 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