Intravenous Immunoglobulin for Recurrent Clostridioides difficile Infection

Abstract

Introduction
Clostridioides difficile infection (CDI) imposes a substantial burden on patients, especially in cases of recurrence, leading to severe complications and prolonged hospitalisation. Recurrence complicates 8% of CDI cases in Ireland with an increased prevalence among elderly, multimorbid patients.

Cases
This series documents three cases of recurrent CDI managed with adjunctive intravenous immunoglobulin (IVIG) therapy in combination with standard antibiotics. The patients were males aged 50-87 with multiple co-morbidities and high clinical frailty scores.

Outcome
All three patients experienced successful resolution of symptoms and remained recurrence free during follow-ups of 16–23 weeks.

Discussion
These cases highlight the potential for IVIG to reduce CDI recurrence, providing an alternative in settings where therapies like bezlotoxumab and faecal microbiota transplant are unavailable. Although limitations, including the small sample size and lack of controlled comparisons, preclude definitive conclusions, the findings underscore the need for further investigation into IVIG’s role in managing recurrent CDI. This report aims to enhance the evidence base, advocating for expanded studies to evaluate the clinical and economic implications of IVIG for recurrent CDI.