Empirical first-line treatment with tigecycline for febrile episodes following abdominal surgery in cancer patients

Abstract

Cancer patients with complicated infections following abdominal surgery represent one of the worst clinical scenarios that is useful for testing the efficacy of empirical antimicrobial therapy. No study so far has evaluated the performance of tigecycline (TIG) when administered as empirical first-line treatment in a homogeneous population of surgical cancer patients with a febrile episode. An observational review of the data records of 24 sequential patients receiving TIG for a febrile episode following a major abdominal procedure in a single cancer institute was performed. Large bowel surgery represented 68% of all procedures, followed by gastric surgery (16%) and urinary-gynaecologic-biliary surgery (16%). Complications following surgery were observed in 68% of febrile episodes, with peritonitis and sepsis accounting for 59% and 24% of complications, respectively.Eight patients needed repeat surgery for source control. The mean duration of TIG treatment was 8 days. Causative pathogens were detected in 16 episodes (64%), and a total of 44 microorganisms were recovered (29% Escherichia coli, 9% Enterococcus faecalis and 9% coagulase-negative staphylococci). TIG was effective in 12 episodes (48%). The success rate was 67% when infectious episodes sustained by intrinsically resistant bacteria and fungi were excluded. Treatment failure was associated with the presence of complications and with microbiologically documented infection. TIG may be useful as a first-line treatment option in cancer patients requiring antibiotic treatment following surgery when complications are not present or suspected on clinical grounds and when local microbial epidemiology shows a low incidence of primary resistant bacteria.

The Antibiotic Drug Tigecycline: A Focus on its Promising Anticancer Properties

“…These findings suggest that administration of supportive medications prior to TIG could significantly reduce the incidence of gastrointestinal side-effects. Finally, other mild side-effects associated with TIG administration were also recorded, such as increased serum concentrations of liver enzyme (Secondo et al, 2010) and liver and renal toxicity (Schwab et al, 2014). Collectively, these studies illustrate the unique clinical presentation in the process of treatment with TIG for infections in patients, particularly in cancer patients.…”

Clinical and microbiological efficacy of tigecycline for complicated skin-soft-tissue and intra-abdominal infections in a Turkish university hospital

“…Especially, immunosuppressive conditions such as malignancy or transplantation could effect clinical cure rates. Secondo et al (16) investigated effectiveness of tigecycline therapy for febrile episodes following abdominal surgery in cancer patients in 2010. The authors mentioned that clinical response rate of empirical tigecycline therapy was 77%.…”