Tigecycline Treatment of Critically Ill Patients: The Latinuser Experience

Abstract

Tigecycline is the first of a new class of antibiotics named glycylcyclines and it was approved for the treatment of complicated intra-abdominal infections and skin and skin structure infections and community-acquired bacterial pneumonia. Notwithstanding this, the tigecycline's pharmacological and microbiological profile encourage physicians' use of the drug in other infections. The aim of this study was to characterize the indications type, pathogens, and outcomes of patients who were treated with tigecycline. We analyzed the tigecycline prescriptions in 209 patients in 23 Latin American centres using an electronic form included in the website LatinUser (http://www.clinicalrec.com.ar). Sixty-six patients (31.5%) received tigecycline for approved indications, and 143 (68.5%) for "off label" indications (47% with scientific support and 21.5% with limited or without any scientific support). The most frequent "off label" use was ventilator-associated pneumonia (VAP) (76 patients). The etiology of infections was established in 88 patients (42%). Acinetobacter spp. (54.5%, in 65% of cases carbapenems-resistant), methicillin-resistant Staphylococcus aureus (12%), and extended spectrum β-lactamases-producing Enterobacteriaceae (10%) were the most common microorganisms isolated. Overall, attending physicians reported clinical success in 144 of the 209 patients (69%). Global mortality proportion was 35,5% (74/209 patients). Our study shows that the off label use of tigecycline is frequent, especially in VAP due to multidrug-resistant pathogens, where the therapeutic options are limited (eg: carbapenems-resistant Acinetobacter spp.). Physicians must evaluate the benefits/risks to use this antibiotic for indications that lack rigorous scientific support.

Tigecycline salvage therapy for critically ill children with multidrug-resistant/extensively drug-resistant infections after surgery

“…This article presents a case series of pediatric patients who received tigecycline as salvage therapy for serious infections due to MDR/XDR bacteria after surgery, representing the largest experience of tigecycline administration in children after surgery in the English language literature. A favorable clinical response was seen in 86% of the patients, which is higher than in other studies (Bassetti et al, 2010;Curcio et al, 2011). This is especially remarkable given the fact that these patients had a greater disease severity and had failed previous treatment with highly potent broad-spectrum antimicrobials.…”

Tigecycline use in critically ill patients: a multicentre prospective observational study in the intensive care setting

“…For instance, in a severe ICU population in Germany, tigecycline was also used mostly in combination (76 %), but the therapy frequently targeted Gram-positive cocci (including enterococci) possibly because of the high frequency of vancomycin-resistant strains. In Latin American countries, the tigecycline use in off-label indications appears to be important [41]. …”

Five-Years Tigecycline Experience an Analysis of Real-Life Data

“…Tigecycline has been used for many indications besides the FDA approved one. Although real life data about its use are limited, some studies involving intensive care patients have suggested promising results with tigecycline treatment (15,16). In this study, ventilatorassociated pneumonia in intensive care patients was one of the most common causes of tigecycline use.…”