Abstract
Tigecycline is the first of a new class of antibiotics named glycylcyclines and is active in vitro against a variety of gram-positive and gram-negative organisms, including nosocomial resistant pathogens such as vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Enterobacteriaceae, and multidrug-resistant- Acinetobacter spp. This medication has been approved by the US Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal infections (cIAI), complicated skin and skin structure infections (cSSSI) and community-acquired bacterial pneumonia. Tigecycline's pharmacological and microbiological profile has also encouraged physicians’ to use the drug in other infections caused by resistant pathogens featuring limited therapeutics options (i.e. hospital-acquired pneumonia-HAP). In this study we publish the conclusions of an expert panel that identify and evaluate the evidence to support the use of Tigecycline in hospitalized patients with one of the following three infections: cSSSI, cIAI and HAP, including ventilator-associated pneumonia. Based on this data the panel developed an Algorithm Rational to Prescribe Tigecycline (ART) for each pathology.
Highlights
IntroductionMultidrug-resistant (MDR) bacteria is found in many hospitals and contributes to increased morbidity, patient length-of-stay, and mortality rates.[1,2]In 2009, the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.), which includes 133 centers from Latin America, published worrisome rates of nosocomial bacterial resistance in the region: 46.3% of vancomycin-resistant Enterococcus faecium (VRE), 46.6% methicillin-resistant Staphylococcus aureus (MRSA), 37.9% of extended-spectrum β-lactamases (ESBL)-producing Klebsiella pneumoniae, and 37.6% of Acinetobacter spp and 35.8% of Pseudomonas aeruginosa carbapenem-resistant and 43.4% of AmpC-producing Enterobacter spp.[3]Rice et al[4] recently reported these as the “ESKAPE” pathogens in order to emphasize that they currently cause the majority of worldwide hospital infections and effectively “escape” the effects of antibacterial drugs.Tigecycline is the first of a new class of antibiotics named glycylcyclines and is active in vitro against a variety of gram-positive and gram-negative organisms, including nosocomial resistant pathogens such as VRE, MRSA, ESBLs-producing Enterobacteriaceae, and MDR-Acinetobacter spp.[5]It has been approved by the US Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal infections (cIAI), complicated skin and skin structure infections (cSSSI)[5] and communityacquired bacterial pneumonia (CABP).[6]Notwithstanding this, the tigecycline’s pharmacological and microbiological profile encourages physicians’ to use the drug in other infections caused by resistant pathogens with limited therapeutics options
Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) (CA-MRSA) isolates are a usually recovered from complicated skin and skin structure infections (cSSSI) which are associated with younger aged patients, sport team participation, recent incarceration, military recruits, snorting/smoking illegal drugs, lower comorbidity index, more frequent visits to bars, raves, and/or clubs
Tigecycline, the first in a new class, the glycylcyclines, appears to hold significant promise as a new agent that can be added to our antimicrobial armamentarium to help overcome antibiotic resistance among clinically important bacteria
Summary
Multidrug-resistant (MDR) bacteria is found in many hospitals and contributes to increased morbidity, patient length-of-stay, and mortality rates.[1,2]In 2009, the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.), which includes 133 centers from Latin America, published worrisome rates of nosocomial bacterial resistance in the region: 46.3% of vancomycin-resistant Enterococcus faecium (VRE), 46.6% methicillin-resistant Staphylococcus aureus (MRSA), 37.9% of extended-spectrum β-lactamases (ESBL)-producing Klebsiella pneumoniae, and 37.6% of Acinetobacter spp and 35.8% of Pseudomonas aeruginosa carbapenem-resistant and 43.4% of AmpC-producing Enterobacter spp.[3]Rice et al[4] recently reported these as the “ESKAPE” pathogens in order to emphasize that they currently cause the majority of worldwide hospital infections and effectively “escape” the effects of antibacterial drugs.Tigecycline is the first of a new class of antibiotics named glycylcyclines and is active in vitro against a variety of gram-positive and gram-negative organisms, including nosocomial resistant pathogens such as VRE, MRSA, ESBLs-producing Enterobacteriaceae, and MDR-Acinetobacter spp.[5]It has been approved by the US Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal infections (cIAI), complicated skin and skin structure infections (cSSSI)[5] and communityacquired bacterial pneumonia (CABP).[6]Notwithstanding this, the tigecycline’s pharmacological and microbiological profile encourages physicians’ to use the drug in other infections caused by resistant pathogens with limited therapeutics options. Tigecycline is the first of a new class of antibiotics named glycylcyclines and is active in vitro against a variety of gram-positive and gram-negative organisms, including nosocomial resistant pathogens such as VRE, MRSA, ESBLs-producing Enterobacteriaceae, and MDR-Acinetobacter spp.[5]. It has been approved by the US Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal infections (cIAI), complicated skin and skin structure infections (cSSSI)[5] and communityacquired bacterial pneumonia (CABP).[6]. In Argentina in 2007, Curcio et al published a report, noting that the tigecycline prescriptions were for non-approved indications in 79% of patients.[7]
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