Clinical efficacy of tigecycline used as monotherapy or in combination regimens for complicated infections with documented involvement of multiresistant bacteria

Abstract

IntroductionTigecycline is an established treatment option for infections with multiresistant bacteria (MRB). It retains activity against many strains with limited susceptibility to other antibiotics. Efficacy and safety of tigecycline as monotherapy or in combination regimens were investigated in a prospective noninterventional study involving 1,025 severely ill patients in clinical routine at 137 German hospitals.Materials and methodsData on the full population have been published; our present analysis focuses on infections caused by MRB. The study population included patients with complicated infections, high disease severity (APACHE II > 15: 65 %) and high MRB prevalence. Most patients had comorbidities, including cardiovascular disease, renal insufficiency, and/or diabetes mellitus. Treatment success was defined as cure/improvement without requirement of further antibiotic therapy.ResultsPathogens isolated from 215 evaluable patients with documented MRB infections included 132 methicillin-resistant Staphylococcus aureus (MRSA), 42 vancomycin-resistant Enterococci (VRE) and 67 Gram-negative extended beta-lactamase (ESBL) producers. Of the MRB subpopulation, 140 patients received tigecycline monotherapy, 75 were treated with combination regimens. High overall clinical success rates were recorded for MRB infections treated with tigecycline alone (94 %) or in combinations (88 %); in detail intraabdominal infections (monotherapy: 90 %; combinations: 93 %), skin/soft tissue infections (93; 100 %), community-acquired pneumonia (100; 100 %), hospital-acquired pneumonia (94,7; 72,7 %), diabetic foot infections (89; 33 %), blood stream infections (100; 100 %) and multiple-site infections (92; 71 %).ConclusionsTigecycline achieved high clinical success rates in patients with documented infections involving MRB strains despite high disease severity. These results add to the evidence indicating that tigecycline is a valuable therapeutic option for complicated infections in severely ill patients with a high likelihood of multidrug-resistant pathogen involvement.

Efficacy and Safety of Tigecycline for Patients with Hospital-Acquired Pneumonia

“…Steady-state plasma and extracellular fluid leak (ELF) concentrations of standard-dose tigecycline were much lower than those of alveolar cells, and attainable ELF concentrations of standard-dose tigecycline were absolutely insufficient to eradicate common pathogens in HAP, which were reliably extracellular bacteria such as MRSA, Escherichia coli [19] and Klebsiella pneumonia [20]. Moreover, the ratio of the area under the concentration-time curve to minimum inhibitory concentration (AUC/MIC) is the main pharmacokinetic/pharmacodynamic (PK/PD) parameter of the antimicrobial activity of tigecycline [21]. AUC/MIC in VAP patients receiving 50 mg of tigecycline every 12 h was 60% lower than that in non-VAP patients [3].…”

Tigeciclina en infecciones de piel y tejidos blandos complicadas.

“…De igual forma Tsoulas en una revisión de los metaanálisis publicados sobre el tratamiento de infecciones de piel y tejidos blandos por SAMR evidencia similar tasa de eficacia clínica y microbiológica al compararla con vancomicina 32 . Heizmann encontró una tasa de éxito en el tratamiento de 94% en IPTB complicadas causadas por SAMR tratadas con tigeciclina 33 .…”

Effectiveness and Safety of Tigecycline Compared with Other Broad‐Spectrum Antimicrobials in Abdominal Solid Organ Transplant Recipients with Polymicrobial Intraabdominal Infections

“…Tigecycline is a glycylcycline antibiotic with a broad spectrum of activity including many antibiotic‐resistant gram‐positive, gram‐negative, and anaerobic organisms . Tigecycline is indicated for the treatment of community‐acquired bacterial pneumonia, complicated skin and skin structure infections, and complicated IAIs.…”

“…Tigecycline is a glycylcycline antibiotic with a broad spectrum of activity including many antibiotic-resistant gram-positive, gram-negative, and anaerobic organisms. 6,7 Tigecycline is indicated for the treatment of community-acquired bacterial pneumonia, complicated skin and skin structure infections, and complicated IAIs. Although tigecycline resistance remains low except for intrinsically resistant Pseudomonas aeruginosa and Proteus species, concerns exist regarding increased risk of mortality when used as initial therapy for serious infections.…”