Bad Bug, No Test: Tigecycline Susceptibility Testing Challenges and Way Forward (original) (raw)
2019, Indian Journal of Medical Microbiology
There is a drastic increase in the incidence of extensively drug-resistant Gram-negative bacteria in the recent times, especially in India. Klebsiella pneumoniae and Acinetobacter baumannii are the two most common pathogens with high drug-resistant rates of up to 40% and 70% carbapenem resistance, respectively. [1] Very few agents are available for the management of these drug-resistant infections. Tigecycline and colistin are the drugs of last resort for treatment as single agents/in combination with other antibiotics. However, both these agents have shortcomings in terms of susceptibility testing, which significantly impact on its right use. Tigecycline is approved for the treatment of Gram-positive and Gram-negative bacteria causing intra-abdominal infections and skin and soft tissue infections. [2] However, it is used off-label for the treatment of other infections such as septicaemia. Tigecycline is a reserve antibiotic increasingly used for the treatment of multidrug-resistant bacteria, especially Klebsiella pneumoniae and Acinetobacter baumannii. At present, there are concerns regarding the testing and interpretation of tigecycline susceptibility to bugs such as K. pneumoniae and A. baumannii, which limit clinicians in appropriate usage. Use of appropriate method for testing such as broth microdilution is essential. In addition, tigecycline susceptibility testing is a challenge due to inconsistent results from various antimicrobial susceptibility testing automated platforms. There is a great need to define a suitable methodology along with interpretive criteria, especially for K. pneumoniae and A. baumannii. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the Food and Drug Administration (FDA) breakpoints show wide variation and are defined for different set of organisms. Non-species-related pharmacokinetic/pharmacodynamic (PK/ PD) breakpoints defined by the EUCAST can be used for organisms such as K. pneumoniae and A. baumannii.
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