Tigecycline combination for ventilator-associated pneumonia caused by extensive drug-resistant Acinetobacter baumannii

He, Hangyong; Zheng, Yali; Sun, Bing; Tang, Xiao; Wang, Rui; Tong, Zhaohui

doi:10.21037/jtd.2016.10.29

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…Recent meta-analyses and retrospective studies show that TGC is not associated with higher survival and may even cause more deaths and other serious side effects in severe forms of infectious disease. [ 21 – 23 ] The FDA in particular, warned against the use of TGC for serious infections in 2010. In contrast, other studies have shown that TGC therapy, when administered as a constituent of combination therapy, (especially high-dose TGC-based therapy), can be effective and can reduce the mortality associated with the severe forms of infectious disease.…”

Section: Discussionmentioning

confidence: 99%

High-dose tigecycline for the treatment of nosocomial carbapenem-resistant Klebsiella pneumoniae bloodstream infections

Geng

Huang

2018

Medicine

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Carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) has become increasingly frequent threat recently, especially in the intensive care unit (ICU). High-dose tigecycline (TGC) regimen is proposed due to the limitation of treatment options. We investigated the efficacy and safety of high-dose TGC combination regimens for treating CRKP BSI. Furthermore, the risk factors for mortality were also determined.This was a single center retrospective cohort study conducted from 2014 to 2016. A total of 40 patients with nosocomial CRKP BSI admitted to the ICU were included; they were classified into two groups according to the treatment regimens with high-dose TGC (HD group) or not (non-HD group). In-hospital mortality rates and microbiologic responses from both groups were reviewed and compared. Besides, the survival and non-survival groups were compared to identify the risk factors of mortality.Twenty-three patients constituted the HD group (high-dosage TGC regimen was administered as 200 mg loading dose followed by 100 mg every 12 h) and 17 patients constituted the non-HD group (standard dose TGC therapy as 100 mg loading dose followed by 50 mg every 12 h and other antibiotics). The in-hospital mortality was 52.2% in the HD group and 76.5% in the non-HD group (P = .117). The Kaplan–Meier test showed significantly longer survival times in the HD group (mean: 83 days vs 28 days; P = .027). Microbiological eradication was observed in 13 patients (56.5%) in the HD group and 6 patients (36.3%) in the non-HD group (P = .184). A smaller fraction of patients in the HD group were subjected to vasoactive therapy (52.2% vs 88.2%; P = .016) compared to the non-HD group. There was no significant difference in the manifestation of adverse effects between the two groups. In the multivariate analysis, multiple organ dysfunction syndrome (MODS), vasoactive therapy, and exposure to carbapenems were regarded as the independent predictors of mortality.A therapeutic regimen consisting of a high dose of TGC was associated with significantly longer survival time and numerically lower mortality in CRKP BSI. Adverse events were not increased with the double dose therapy.

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Section: Discussionmentioning

confidence: 99%

High-dose tigecycline for the treatment of nosocomial carbapenem-resistant Klebsiella pneumoniae bloodstream infections

Geng

Huang

2018

Medicine

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“…In two retrospective studies evaluating tigecycline monotherapy (100 mg IV loading dose, then 50 mg IV q12h) versus tigecyclinebased combination therapy (multiple agents), there was no difference in clinical success, mortality, or microbiological outcomes [64,65]. Similarly, when evaluating tigecycline-based combination therapy versus non-tigecycline-based combination therapy, clinical cure and mortality outcomes were similar [66][67][68][69], while microbiological eradication with tigecyclinebased therapy was significantly lower in one trial [67]. In a more recent evaluation of 238 adult ICU patients with CRAB pneumonia, those treated with tigecycline-based combination therapies had higher ICU mortality than non-tigecycline therapy (adjusted odds ratio 2.30, 95% confidence interval 1.19-4.46) [70].…”

Section: Combination Therapiesmentioning

confidence: 98%

Developments for the Treatment of Invasive Infections Due to Multidrug-resistant Acinetobacter baumannii

David¹,

Drew²,

Wilson³

2019

JRI

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Acinetobacter baumannii is a significant pathogen in healthcare settings (specifically prominent in healthcare-and ventilator-associated pneumonia) due primarily to its virulence and resistance to a wide variety of antimicrobial drug classes, including carbapenems (CRAB). Existing therapies (notably polymyxins, minocycline, tigecycline, amikacin, and sulbactam) often result in suboptimal tissue concentrations, high rates of toxicity, and increasing rates of resistance. Although utilizing combinations of antibiotics (specifically those containing colistin) have been employed, results have been mixed, and control trials are lacking. Eravacycline is a novel tetracycline with an improved pharmacokinetic profile and more potent activity against A. baumannii relative to tigecycline. Cefiderocol has a unique mechanism of action that has performed well in vitro against multidrugresistant (MDR) and CRAB isolates. Limited clinical data exists with each of these agents. Other novel antimicrobials are still in early phase clinical trials (ETX2514/sulbactam, TP-271, TP-6076, VNRX-5133/cefepime, cefepime/zidebactam, AIC-499, GSK3342830, and SPR741) while further research is underway for non-antibiotic approaches, specifically monoclonal antibodies and bacteriophage therapies.

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“…Indeed, it is certainly relevant to have the same fears with respect to antifungals use that with respect to antibiotics (27,28). Limiting wide use would limit the emergence of resistant strains (29).…”

Section: Editorialmentioning

confidence: 99%

What is the role of empirical treatment for suspected invasive candidiasis in non-neutropenic non transplanted patients in the intensive care unit?—Empiricus strikes back!

Bretonnière¹,

Lakhal

Lepoivre

et al. 2016

J. Thorac. Dis.

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Tigecycline combination for ventilator-associated pneumonia caused by extensive drug-resistant Acinetobacter baumannii

Cited by 14 publications

References 21 publications

High-dose tigecycline for the treatment of nosocomial carbapenem-resistant Klebsiella pneumoniae bloodstream infections

High-dose tigecycline for the treatment of nosocomial carbapenem-resistant Klebsiella pneumoniae bloodstream infections

Developments for the Treatment of Invasive Infections Due to Multidrug-resistant Acinetobacter baumannii

What is the role of empirical treatment for suspected invasive candidiasis in non-neutropenic non transplanted patients in the intensive care unit?—Empiricus strikes back!

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