Abstract
We aimed to evaluate tigecycline on the clinical effectiveness in treating complicated skin and soft tissue infections (cSSTI), complicated intra-abdominal infections (cIAI), and pneumonia, caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, as data are limited. From three medical centers in Taiwan, we retrospectively studied the cSSTI, cIAI, and/or pneumonia caused by ESBL-producing Enterobacteriaceae. Among the 71 patients, including 39 patients infected with Klebsiella pneumoniae, 30 infected with Escherichia coli and others, the clinical success rate of tigecycline-based therapy was 80–90% for pneumonia and cSSTI caused by E. coli and 50–60% for cIAI caused by K. pneumoniae and E. coli. Microbiological and clinical outcome of pneumonia caused by carbapenem-resistant K. pneumoniae was poor. Univariate Cox analysis showed that dyspnea, SOFA score, septic shock, thrombocytopenia, prolonged prothrombin time, and lesser microbiological eradication were significant factors associated with 30-day mortality after the end of therapy. Cox regression proportional hazards model revealed dyspnea and a SOFA score > 8 to be independently associated with time to death. For ESBL producers, tigecycline showed good effects for cSSTI and pneumonia by E. coli, ordinary for cIAI, but ineffective for pneumonia by K. pneumoniae. Dyspnea and a high SOFA score predict a poor outcome.
Highlights
IntroductionTigecycline is a glycylcycline antibiotic with a broad-spectrum antimicrobial activity against multidrug-resistant organisms (MDROs), such as methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, Acinetobacter baumannii groups
Tigecycline is a glycylcycline antibiotic with a broad-spectrum antimicrobial activity against multidrug-resistant organisms (MDROs), such as methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, Acinetobacter baumannii groupsAntibiotics 2020, 9, 231; doi:10.3390/antibiotics9050231 www.mdpi.com/journal/antibioticsAntibiotics 2020, 9, 231 and even those with carbapenem resistance [1,2]
A total of 71 cases that received tigecycline-based therapy for ESBL-producing Enterobacteriaceae with or without carbapenem resistance were enrolled in the study
Summary
Tigecycline is a glycylcycline antibiotic with a broad-spectrum antimicrobial activity against multidrug-resistant organisms (MDROs), such as methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, Acinetobacter baumannii groups. Antibiotics 2020, 9, 231 and even those with carbapenem resistance [1,2]. The activity of tigecycline against MDROs remains stable over time [3]. The in vitro activity does not always guarantee an adequate clinical response [4]. Tigecycline is approved for the treatment of complicated skin and soft tissue infections (cSSTI), complicated intra-abdominal infections (cIAI), and community-acquired bacterial pneumonia [5]. Carbapenems have been recommended as the drug of choice for severe infections caused by ESBL producers. Clinical data remain limited regarding tigecycline used for the treatment of the infections caused by ESBL-producers [5,6]
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