Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis

Abstract

Severe infectious complications remain the main cause of mortality in leukemia patients due to a long period of profound neutropenia. Standardized regimens for antimicrobial, antifungal, and antiviral prophylaxis and therapy in neutropenic patients have improved infection-associated mortality. Nevertheless, many patients are refractory to these multidrug approaches. Tigecycline is a last-resort antibiotic with a broad-spectrum activity; unfortunately, clinical experience in multidrug-resistant febrile neutropenia is limited. The aim was to evaluate the efficacy of tigecycline treatment in comparison to standard treatment in this patient cohort. In this single center analysis, we analyzed the clinical courses of 73 patients with acute leukemia and diagnosis of febrile neutropenia resistant to hospital-based multidrug escalation levels who continued on a standard approach without antibiotics as the last resort (n = 30) or were switched to tigecycline in addition to carbapenem treatment (n = 43). We observed comparable overall response rates (decrease in C-reactive protein or resolution of fever) in both patient cohorts. Switching the antibiotic approach to tigecycline showed lower absolute sepsis (33% vs. 47%, p = 0.235) and infection-associated mortality rates (5% vs. 13%, p = 0.221). Prospective larger randomized studies are necessary to underline these results and to be able to generate reliable statistics.

Tigecycline as salvage treatment of febrile neutropenia in patients with haematological malignancies—a retrospective single-centre analysis of 200 cases

“…One reason could be, that in that study a response required a decrease in CRP in addition to defervescence. But similar to our study, no significant difference in response rate or 30-day mortality rate could be shown [21]. In one of the few prospective randomized controlled studies, tigecycline was combined with piperacillin/tazobactam as first-line treatment for febrile neutropenia and showed a higher response rate of 67.9% compared to piperacillin/tazobactam alone (44.3%).…”

Systematic Review of Beta-Lactam vs. Beta-Lactam plus Aminoglycoside Combination Therapy in Neutropenic Cancer Patients

“…While there are some studies on the use of tigecycline in hematologic malignancy patients, almost none have identified resistance genes. Some reports suggest that susceptibility to tigecycline is favorable in carbapenem strains with a higher MIC [93][94][95], but the clinical outcomes are not consistent [96][97][98]. One study indicates that combining piperacillin/tazobactam with tigecycline is considered safe and more effective compared to using piperacillin/tazobactam by itself in febrile neutropenic hematologic cancer patients at high risk [99].…”

Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

“…Moreover, many studies have shown that the use of tigecycline benefits immunosuppressed patients having CRGNB-BSI or other types infection. [30][31][32] Some studies pointed out that high-dosage tigecycline therapy (200 mg loading dose followed by 100 mg every 12 h) has better outcomes in the treatment of severe infections compared with standard-dosage tigecycline therapy (100 mg loading dose followed by 50 mg every 12 h) and other non-tigecycline-containing regimens. 33 In our study, only 20.87% accepted the high-dosage tigecycline therapy, and low serum levels of the drug may lead to an unfavorable microbiological response.…”