Prospective, Non-Interventional, Multi-Centre Trial of Tigecycline in the Treatment of Severely Ill Patients with Complicated Infections – New Insights into Clinical Results and Treatment Practice

Eckmann, Christian; Heizmann, W.; Leitner, Eva; Eiff, Christof von; Bodmann, Klaus-Friedrich

doi:10.1159/000329406

Cited by 32 publications

(17 citation statements)

References 64 publications

(54 reference statements)

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“…Tigecycline is becoming a useful alternative against multidrug-resistant bacteria due to its broad spectrum covering both Gram-positive bacteria including methicillin-resistant Staphylococcus aureus and Gram-negative organisms except Pseudomonas aeruginosa [29,30,31]. By using the Etest method we found that 97.9% of the typed E. coli (n = 195) and 78.8% of the typed K. pneumoniae (n = 33) ESBL-producing isolates were susceptible to tigecycline, whereas a previous surveillance study performed in 2005 in Germany reported 100% of the tested ESBL-producing E. coli isolates to be susceptible to tigecycline [32].…”

Section: Discussionmentioning

confidence: 99%

In vitro Activity of Tigecycline and Molecular Characterization of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates from a University Hospital in South-Western Germany

et al. 2012

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Background: Extended-spectrum β-lactamase (ESBL)-producing organisms are spreading worldwide in hospital and community settings. Methods: A total of 328 unduplicated ESBL-producing Enterobacteriaceae isolated in 2008 and 2009 at the University Hospital of Tübingen were analysed retrospectively. Results:Escherichia coli (n = 253) and Klebsiella spp. (n = 46) were the most frequent ESBL-producing species. The ESBL rates among E. coli and Klebsiella spp. increased from 3.8 and 2.1%, respectively, in 2008, to 5.2 and 2.4%, respectively, in 2009. Two E. coli and 3 Klebsiella pneumoniae ESBL producers were non-susceptible to ertapenem, most likely due to loss of porins. Antimicrobial susceptibility testing of selected, molecularly characterized ESBL producers revealed susceptibility to tigecycline among 97.9% (191/195) of the E. coli and 78.8% (26/33) of the K. pneumoniae isolates. PCR analysis and sequencing showed the presence of CTX-M-type enzymes in 91.3% of the E. coli and 87.9% of the K. pneumoniae isolates, whereby bla_CTX-M-15 was the most frequent ESBL gene both in E. coli (50.0%) and K. pneumoniae (51.5%). Only 7 single cases of potential patient-to-patient transmissions of E. coli strains were observed. Conclusions: Our data suggest that the increase in ESBL-producing E. coli and K. pneumoniae isolates at our hospital is mainly caused by growing import of Enterobacteriaceae harbouring CTX-M-type ESBLs.

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Section: Discussionmentioning

confidence: 99%

In vitro Activity of Tigecycline and Molecular Characterization of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates from a University Hospital in South-Western Germany

et al. 2012

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“…MRSA is a public health problem due to its rampant spread in hospital departments and the increasing emergence of strains with reduced susceptibility to glycopeptides [6]. Previous studies of nasal carriage produced lower rates of MRSA prevalence, which may be unsurprising given the overall MRSA prevalence in the countries that were the settings of these previous investigations [7].…”

Section: Discussionmentioning

confidence: 99%

The Screening of Methicillin-Resistant Staphylococcus aureus in Vascular Surgery Patients: A Comparison of Molecular Testing and Broth-Enriched Culture

Fiolić

Bošnjak²,

Šnajdar³

et al. 2012

Chemotherapy

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Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major global health care-associated pathogen. This study sought to examine the prevalence of MRSA in patients who were admitted to a vascular surgery ward during a 3-month period. Methods: MRSA screening was accomplished through the acquisition of nasal, throat and perineal swabs. These swabs were placed in tryptic soy broth that had been supplemented with 6.5% NaCl and incubated for 24 h. The resulting isolates were subcultured on agar plates containing 5% sheep blood. The BD GeneOhm MRSA assay for screening swabs was performed in accordance with the manufacturer’s instructions. Results: A total of 58 patients were included in the study and swabs from 232 sites were obtained during the sampling period. MRSA was detected in 33 samples of 12 patients during the study period; thus, there was a 20.6% prevalence of patients who were recognized as MRSA carriers. There were discrepancies between the results of classical bacteriological screening and molecular MRSA detection methods in 8 of the patients. Conclusions: Nasal, throat and perineal MRSA screening can detect the carriage of this pathogen and allow for the timely use of appropriate infection control measures. The choice of screening techniques poses a challenge; it has been demonstrated that molecular detection methods should be performed with great sensitivity, specificity and, most importantly, speed. The cost of the PCR screening method is the only disadvantage of this approach.

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“…This study which included 1,025 patients treated in a clinical routine setting at German hospitals was initiated shortly after tigecycline was introduced in Germany. An interim analysis of a subset of patients had been previously published in this journal [32]. The current analyses of the total patient population are primarily focused on the safety profile of tigecycline and treatment modalities in these severely ill patients with complicated infections.…”

Section: Introductionmentioning

confidence: 99%

Therapy of 1,025 Severely Ill Patients with Complicated Infections in a German Multicenter Study: Safety Profile and Efficacy of Tigecycline in Different Treatment Modalities

Bodmann¹,

Heizmann²,

Eiff

et al. 2012

Chemotherapy

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This large prospective non-interventional study investigated the effects of tigecycline either as single agent or in combination with other antimicrobial agents in 1,025 patients treated in clinical routine at German hospitals. Sixty-five percent of the patients had APACHE II scores >15, indicating high overall disease severity. Complicated intra-abdominal infections (cIAI) or complicated skin and skin tissue infections (cSSTI) were the most common indications, with Staphylococcus aureus, Enterococcus faecium and Escherichia coli being the most frequently isolated pathogens. Clinical success was reported at the end of tigecycline therapy in 74.2% of the total population, in 75.4% of the cIAI and in 82.2% of the cSSTI patients. The subpopulation (28.0% of the patients) infected with multidrug-resistant pathogens (methicillin-resistant S. aureus, extended-spectrum β-lactamase producers and vancomycin-resistant enterococci) were treated with similar success rates as the overall population. Tigecycline was generally well tolerated. Drug-related adverse events (AEs) were reported in 7.7% of the total population; 2.5% had serious AEs mostly attributable to inefficacy of therapy or deterioration of the disease. Mortality rates were consistent with the types of infection and severity of illness. There was no indication of excessive mortality associated with tigecycline as had been suggested in previously performed meta-analyses. In this large non-interventional study performed in the clinical routine setting, tigecycline achieved favorable clinical success rates in a patient population with high severity of illness and a high prevalence of multidrug-resistant pathogens and showed a good safety and tolerability profile.

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Prospective, Non-Interventional, Multi-Centre Trial of Tigecycline in the Treatment of Severely Ill Patients with Complicated Infections – New Insights into Clinical Results and Treatment Practice

Cited by 32 publications

References 64 publications

In vitro Activity of Tigecycline and Molecular Characterization of Extended-Spectrum Beta-Lactamase-Producing <b><i>Escherichia coli</i></b> and <b><i>Klebsiella pneumoniae</i></b> Isolates from a University Hospital in South-Western Germany

In vitro Activity of Tigecycline and Molecular Characterization of Extended-Spectrum Beta-Lactamase-Producing <b><i>Escherichia coli</i></b> and <b><i>Klebsiella pneumoniae</i></b> Isolates from a University Hospital in South-Western Germany

The Screening of Methicillin-Resistant <b><i>Staphylococcus aureus</i></b> in Vascular Surgery Patients: A Comparison of Molecular Testing and Broth-Enriched Culture

Therapy of 1,025 Severely Ill Patients with Complicated Infections in a German Multicenter Study: Safety Profile and Efficacy of Tigecycline in Different Treatment Modalities

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