Abstract
There is existing controversy regarding the efficacy of tigecycline (TG) in treating complicated urinary tract infections (cUTIs) because of its pharmacokinetic concerns. We present three patients with cUTIs caused by carbapenem-resistant gram-negative (GN) pathogens successfully treated with high-dose tigecycline (HDT)-based regimens, as cefiderocol and aztreonam were not available in our country. The first case describes a 67-year-old patient with diabetes, prostate cancer, and double J ureteral stenting who was hospitalized with a febrile, complicated urinary tract infection (cUTI). Urine and blood cultures were positive for metallo-beta-lactamases (MBL)-producing extensively drug-resistant (XDR) Klebsiella pneumoniae(cefiderocol-susceptible). The synergy between TG and colistin using thein vitro E-test was demonstrated, and the patient was started on this regimen using HDT. Clinical and microbiological cures were achieved, and the patient was discharged home. The second case presents a 70-year-old patient with urethral pathology who was hospitalized with the diagnosis of a lower cUTI caused by an MBL-producing pan-drug-resistant (PDR) Klebsiella pneumoniae.Thein vitro E-test showed synergy between TG and colistin, and our patient was successfully treated with this HDT-based combination. The third case emphasizes a 63-year-old patient with insulin-dependent diabetes, Child B cirrhosis, and a right double J ureteral stent who was hospitalized with a febrile cUTI. Urine and blood cultures were positive for carbapenem-resistant XDR Acinetobacter baumannii(susceptible to colistin and TG). Colistin was administered for only 96 hours because of stage II acute kidney injury, and we continued the treatment with HDT in monotherapy. The patient was discharged home, and no urinary tract infection relapse was seen for six months. Favorable clinical and microbiological outcomes were achieved with TG-based regimens in our cUTI cases. We highlight the role of antibiotic synergy determined by the in vitroE-test in two cases of MBL-producing XDR/PDRKlebsiella pneumoniae.
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