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

Abstract

PurposeThis prospective observational study aimed at describing prescription patterns of tigecycline and patient outcomes in 26 French intensive care units (ICU).MethodsData of consecutive cases of adult patients treated with tigecycline were collected from the initiation until 7 days after the end of treatment. Response to treatment was classified as success, failure or undetermined and analyses were presented according to severity (SOFA score <7 or ≥7). Survival was recorded at 28 days.ResultsA total of 156 patients were included (64 % male, age 60 ± 15 years). At inclusion, 53 % had a SOFA score ≥7; 93 % had received prior anti-infective agents. Tigecycline was given as first-line treatment in 47 % of patients, mostly in combination (67 %), for intra-abdominal (IAI 56 %), skin and soft tissue (SSTI 19 %) or other infections. A total of 76 % of the treated infections were hospital-acquired. Bacteraemia was reported in 12 % of patients. Median treatment duration was 9 days. Tigecycline was prematurely stopped in 42 % patients. The global success rate was 60 % at the end of treatment, and significantly higher with treatment duration more than 9 days (76 vs. 47 %, P < 0.001). Success rate was 65 % for patients alive at the end of treatment. Success rates tended to decrease with illness severity, immunosuppression, bacteraemia and obesity. Survival rate at day 28 was 85 % in the whole cohort and significantly higher in the less severely ill patients (P < 0.001).ConclusionsTigecycline success rates appear comparable to those reported in clinical studies in ICU with severe infections. Tigecycline could be an alternative in ICU patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-014-3323-7) contains supplementary material, which is available to authorized users.

Asynchronies during mechanical ventilation are associated with mortality

“…On the basis of the pooled data analysis, the FDA recommended that alternatives to tigecycline should be considered in patients with severe infections. In their interesting article Montravers et al [31] conclude that tigecyclin success rates in patients in ICU with severe infections appear comparable to those reported with other antibiotics; the overall success rate was 60 % at the end of treatment, and 53 % 7 days later. Furthermore, they report a survival rate of 85 % at day 28.…”

Is there a future for tigecycline?

“…In their interesting and welcome article published in the current issue of intensive care medicine, Montravers et al [9] conclude that tigecycline success rates in patients in ICU with severe infections appear comparable to those reported with other antibiotics; the overall success rate was 60 % at the end of treatment, and 53 % 7 days later. Furthermore, they report a survival rate of 85 % at day 28.…”

“…This is greatly supported by the large observational studies from five European countries and by the Montravers study mentioned above [9,10]. Well-controlled prospective studies are necessary to evaluate tigecycline's efficacy and safety profile at high doses.…”

Treatment of severe MRSA infections: current practice and further development

“…Tigecycline, a glycylcycline highly active against MRSA in vitro, cannot be recommended as first-line therapy in serious MRSA infections, as there is insufficient data available and reports exist of higher mortality and lower cure probably due to PK/PD considerations including high protein biding, inadequate AUC/ MIC with standard dosing, low serum concentrations, and poor penetration into some tissues [12]. However, it may be useful, in combination regimens, namely for skin and soft tissue or intra-abdominal infections [13]. Oritavancin, dalbavancin, and telavancin are semisynthetic lipopolypeptide analogues of vancomycin.…”