Print E-mail
Volume 44, Number 1, February 2011

Clinical experience with tigecycline as treatment for serious infections in elderly and critically ill patients


Shu-Chen Kuo, Fu-Der Wang, Chang-Phone Fung, Liang-Yu Chen, Su-Jung Chen, Mei-Chun Chiang, Shih-Fen Hsu, Cheng-Yi Liu


Received: April 20, 2009    Revised: September 13, 2009    Accepted: October 29, 2011   

 

Corresponding author:

Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road
Section 2, Taipei, 11217, Taiwan.



 

Background and purpose: 

Tigecycline was approved for the treatment of complicated intra-abdominal and complicated skin/skin structure infections. Because of its in vitro effectiveness for multidrugresistant (MDR) isolates, tigecycline has been prescribed more broadly. This study evaluated tigecycline use after its first introduction in Taiwan and experience with tigecycline for the treatment of MDR Acinetobacter baumannii (MDRAB) infection, especially for ventilatorassociated pneumonia.



 

Methods:

Patients treated with tigecycline were collected retrospectively from February 2008 to July 2008 in Taipei Veterans General Hospital, a 2,900-bed tertiary care medical center in Taiwan. Patients were divided into three groups according to the indications: Group 1, Food and Drug Administrationeapproved indications; Group 2, health careeassociated pneumonia (HAP); and Group 3, urinary tract infection, osteomyelitis, bacteremia, etc. Cases of MDRAB were also identified.



 

Results:

Among 66 cases, indications for the administration of tigecycline included Food and Drug Administrationeapproved indications (12, 18.2%), HAP (38, 57.6%), bacteremia (3, 4.5%), catheter-related infections (3, 4.5%), urinary tract infection (4, 6.1%), osteomyelitis (4, 6.1%), and others (2, 3%). Clinical outcome was positive in 20 cases, with higher clinical success rate for Group 1 than Group 2, which may correlate with higher Sequential Organ Failure Assessment score, older age, and more frequent intensive care admission in Group 2. Of the microbiologically evaluable cases, MDRAB predominated (33/51, 64.7%). Among infections with MDRAB (excluding pneumonia without ventilator), the clinical success rate was 12% (3/25).



 

Conclusion:

The most common indication for the prescription of tigecycline was HAP. Success rate for MDRAB infection was lower than that previously reported, possibly because of serious underlying conditions and comorbidities in our patients. Because of limited choices, physicians should weigh the risk and benefit for prescribing tigecycline.



 

Key words:

Acinetobacter baumannii; Multidrug-resistant; Tigecycline; Ventilator-associated pneumonia