Tigecycline Versus Colistin in the Treatment of Carbapenem-resistant Acinetobacter baumannii Complex Osteomyelitis

Abstract

Abstract. Background: Acinetobacter baumannii complex is an increasingly important cause of osteomyelitis. It is considered a difficult to treat agent, due to increasing antimicrobial resistance and few available therapeutic options.Objective: To compare effectiveness and tolerability of tigecycline and colistin in patients with osteomyelitis caused by carbapenem-resistant A. baumannii complex (CRABC).Methods: This retrospective review included all patients admitted to a 150-bed tertiary hospital from 2007 to 2015 with microbiologically confirmed CRABC osteomyelitis for which they received tigecycline or colistin. Data on demographic and clinical characteristics, adverse events, and outcomes 12 months after the end of antimicrobial treatment were analysed and stratified according to the antimicrobial used.Results: 65 patients were included, 34 treated with colistin and 31 with tigecycline. There were significantly more men (P = 0.028) in the colistin group, and more smokers (P = 0.021) and greater occurrence of chronic osteomyelitis (P = 0.036) in the tigecycline treatment group. Median duration of therapy was 42.5 days for colistin and 42 days for tigecycline, with no significant difference. Overall incidence of adverse events was higher in the colistin group (P = 0.047). In particular, incidence of renal impairment was also higher in this group (P = 0.003). Nausea and vomiting were more frequent with tigecycline (P = 0.046). There were no significant differences between groups in relapse, amputation, or death.Conclusions: Tigecycline had a better safety profile than colistin in the treatment of osteomyelitis due to CRABC, with no significant difference in outcomes after 12 months of follow-up.

Efficacy and Safety of Colistin versus Tigecycline for Multi-Drug-Resistant and Extensively Drug-Resistant Gram-Negative Pathogens—A Meta-Analysis

“…In contrast, for the in-hospital mortality, reported in six studies [ 12 , 15 , 16 , 17 , 19 , 23 ], no statistically significant advantage was reported with either monotherapy (OR = 1.42, 95% CI [0.55, 3.70], p = 0.47), Figure 5 , with a significant heterogeneity observed (I 2 = 51%, p = 0.07). However, when reversing the heterogeneity via the sensitivity analysis, by excluding the study by Ku et al [ 15 ], a statistically reduced in-hospital mortality rate was observed in favour of the colistin monotherapy (OR = 2.27, 95% CI [1.24, 4.16], p = 0.008), with no heterogeneity (I 2 = 0%, p = 0.57), Figure S1.2 .…”

“…Fourteen studies [ 7 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] involving 1163 patients were included in the current study. A total of 789 patients were treated with tigecycline and 938 patients were treated with colistin.…”

“…Three studies [ 12 , 17 , 23 ] reported on clinical response, and the effect estimate showed no significant difference between the compared groups (odds ratio (OR) = 0.99, 95% confidence interval (CI) [0.50, 1.95], p = 0.97). No significant heterogeneity was found (I 2 = 0%, p = 0.50), Figure 2 .…”

“…Nine studies [ 7 , 12 , 14 , 15 , 16 , 17 , 19 , 23 , 24 ] reported the overall mortality of tigecycline monotherapy versus colistin monotherapy. The effect estimate did not favour either drug (OR = 0.82, 95% CI [0.55, 1.23], p = 0.34), Figure 3 .…”

Real-World, Multicenter Case Series of Patients Treated with Oral Omadacycline for Resistant Gram-Negative Pathogens

“…Furthermore, clinical success was 75.0% in bone/joint infections caused by CRAB, which is higher than reported previously (approx. 40%) [16]. A common resistance mechanism in CRAB is the production of betalactamases (e.g., Class D, OXA-type), which do not affect the in vitro activity of OMC; therefore, OMC may represent a viable option in these clinical isolates, if proven efficacious [17].…”