Clinical and Microbiological Outcomes of Serious Infections with Multidrug-Resistant Gram-Negative Organisms Treated with Tigecycline (original) (raw)
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Journal of Antimicrobial Chemotherapy, 2008
Antimicrobial drug resistance is spreading among Enterobacteriaceae, limiting the utility of traditionally used agents. We sought to systematically review the microbiological activity and clinical effectiveness of tigecycline for multidrug-resistant (MDR) Enterobacteriaceae, including those resistant to broad-spectrum b-lactams due to the expression of extended-spectrum b-lactamases (ESBLs), AmpC enzymes and carbapenemases (including metallo-b-lactamases). Methods: PubMed was searched for articles including relevant data. Results: Twenty-six microbiological and 10 clinical studies were identified. Tigecycline was active against more than 99% of 1936 Escherichia coli isolates characterized by any of the above resistance patterns (including 1636 ESBL-producing isolates) using the US Food and Drug Administration (FDA) breakpoint of susceptibility (MIC 2 mg/L). Findings were not different using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoint (1 mg/L). Susceptibility rates for Klebsiella spp. with any of the above resistance patterns were 91.2% for 2627 isolates by the FDA criteria and 72.3% for 1504 isolates by the EUCAST criteria (92.3% for 2030 and 72.3% for 1284 ESBLproducing isolates, by the FDA and EUCAST criteria, respectively). The degree of microbiological activity of tigecycline against 576 MDR Enterobacter spp. isolates was moderate. In clinical studies, 69.7% of the 33 reported patients treated with tigecycline achieved resolution of an infection caused by a carbapenem-resistant or ESBL-producing or MDR Enterobacteriaceae. Conclusions: Tigecycline is microbiologically active against almost all of the ESBL or MDR E. coli isolates and the great majority of ESBL or MDR Klebsiella spp. isolates. Further evaluation of its clinical utility against such resistant Enterobacteriaceae, particularly regarding non-labelled indications, is warranted.
Tigecycline in the treatment of infections from multi-drug resistant gram-negative pathogens
Journal of Infection, 2009
Objective: This observational retrospective study aims to present early experience with tigecycline (TIG) in the treatment of infections due to multi-drug resistant (MDR) microorganisms. Methods: Adult patients included, received TIG for >5 days either as monotherapy (M group) or as presumed active monotherapy (PAM group). In the PAM group, all co-administered antimicrobial(s) were resistant in vitro against the targeted pathogen(s) or had been clinically and microbiologically failing after !5 days of therapy despite in vitro susceptibility. Results: Forty-five patients (35 in ICU) were treated for 28 Acinetobacter baumannii and 23 Klebsiella pneumoniae infections [21 ventilator-associated and healthcare-acquired pneumonia (VAP/HCAP), 10 bloodstream infections (BSI) and 14 surgical infections (SI)]. Successful overall clinical outcome was 80%, i.e. 81.8% in M group, 78.3% in PAM group, 90.5% in VAP/ HCAP, 80% in BSI, 64.3% in SI and 85% in the cases with septic shock. Superinfections from Enterobacteriaceae inherently resistant to tigecycline occurred in 31.8% of M and 13% of PAM group (p < 0.001). Journal of Infection (2009) 58, 273e284 Conclusion: TIG represents a promising option in infections from MDR pathogens, however, further clinical experience is required.
Antibiotic Effect of Tigecycline on Gram Negative Bacilli
Introduction: Resistance to multiple antibiotics among Gram negative bacilli (GNB) is high in India. Tigecycline, a glycylcycline antibiotic is a newer treatment option for emerging single or multidrug-resistant (MDR) GNB. Material and Methods: All the samples received in the Microbiology laboratory were processed according to standard protocols. Once identified, they were subjected to antibiotic susceptibility testing by disk diffusion method on Mueller Hinton agar. We evaluated the in vitro activity of tigecycline and compared it against other antimicrobials. Among 356 isolates, [Escherichia coli (126), Klebsiella spp (61), Pseudomonas aeruginosa (133), Acinetobacter spp. (23) and Proteus (13)] from patients with, skin and soft tissue (SSTI) including surgical site, urinary tract and respiratory infections were isolated in our laboratory, Department of Microbiology, Mandya Institute of Medical Sciences, Mandya. Susceptibility to antimicrobials besides tigecycline included amikacin, imipenem, levofloxacin, meropenem, and piperacillin/tazobactam was determined by disk diffusion method. Results: Tigecycline was active against all E. coli and Klebsiella spp by disc diffusion method. MDR Acinetobacter spp. showed lower susceptibility (70.6%) to tigecycline and Pseudomonas spp and Proteus spp showed high resistance. Increased resistance was seen to other antimicrobials among Extended Spectrum Beta Lactamases(ESBL) producing E. coli, Klebsiella spp., Metallo Beta Lactamase (MBL) producing P. aeruginosa. Discussion: Tigecycline shows high potency against Gram-negative bacilli belonging to family Enterobacteriaceae in whom multi-drug resistant strains have emerged as important nosocomial pathogens. Tigecycline is highly active against Enterobacteriaceae, regardless of the presence or absence of ESBLs, >99% of all of the tested strains were inhibited.In the present study we found that tigecycline had good activity against tested E.coli and Klebsiella spp. Conclusion: Tigecycline is an alternative option for emerging multidrug resistant (MDR) pathogens exhibiting promising spectrum/potency exceeding currently available agents seen in India.
International Journal of Health Sciences and Research, 2014
Introduction: Tigecycline is an antibiotic belonging to the glycylcyclines class with in vitro activity against most gram negative bacteria, even multidrug resistant pathogens. It is considered to be a newer treatment option for emerging multidrug resistant pathogens. Objectives: To evaluate the in vitro activity of tigecycline against Multidrug resistant gram negative bacteria isolated from various clinical specimens to compare with other antimicrobials. Materials & methods: A total of 150 multidrug resistant isolates of Enterobacteriaceae (113) and Acinetobacter spp (37) were tested for tigecycline susceptibility by the E-test and disc diffusion method. Results: Tigecycline showed good microbiological activity against all the isolates of multidrug resistant gram negative bacteria with 100% susceptibility in E. coli & Enterobacter species, 94% in Klebsiella species and 81.08% in Acinetobacter spp. isolates. Conclusion: Tigecycline was found to be highly effective against multidrug resistant gram negative bacteria. Therefore it is an alternative option for treatment of complicated skin &soft tissue and intraabdominal infections caused by such multidrug resistant pathogens.
Journal of Antimicrobial Chemotherapy, 2009
Multidrug-resistant Acinetobacter baumannii (MRAB) is an increasing problem in UK hospitals, with many strains now resistant to all available antibiotics except polymyxins. Tigecycline has been used for the treatment of MRAB as it demonstrates activity in vitro, but there are limited data on its clinical efficacy in Gram-negative infections, especially those involving the lower respiratory tract or bacteraemia. A retrospective study of the clinical and microbiological outcomes of all patients treated with tigecycline for MRAB over an 18 month period was undertaken. Thirty-four patients received tigecycline for MRAB or polymicrobial infection involving MRAB. Twenty-three (68%) had a positive clinical outcome: microbiological clearance was demonstrated in 10 of these. The overall mortality was 41% (n = 14), with nine deaths directly attributable to sepsis. Three patients had episodes of Gram-negative bacteraemia while receiving treatment with tigecycline, with documented resistance occurring in one patient. Overall, the correlation between microbiological and clinical outcomes was poor. While tigecycline retains excellent in vitro activity against MRAB, its clinical efficacy remains uncertain. A prospective study, including the use of tigecycline in combination with other antimicrobial agents, should be undertaken to define its role in the treatment of MRAB.
Background & objectives: Emergence and spread of antibiotic resistance among bacteria pose a challenge to clinicians due to limited therapeutic options available. Multi drug resistant (MDR) bacteria are known to cause life threatening infections in intensive care settings. Tigecycline is a newer glycycline antibiotic, considered as therapeutic option for MDR gram positive and gram negative bacteria. Aim of this study was to evaluate in-vitro susceptibility of tigecycline in MDR bacteria. Methods: We studied the in-vitro activity of tigecycline in 100 MDR bacteria isolated from blood, skin, soft tissue and surgical site infections, urine, sputum, bronchoalveolar lavage, CSF and other body fluids of patients admitted to a tertiary care hospital in South India. MDR bacteria tested for tigecycline susceptibility by disc diffusion and E-test included: Methicillin resistant S.aureus (MRSA) (35), extended spectrum β lactamase (ESBL) producing Enterobacteriaceae (36), P.aeruginosa (15) and Acinetobacter spp. (14). Results: Tigecycline was found effective against all isolates of MRSA (MIC 90 ≤0.25µgm/ml). All ESBL producing E.coli, Klebsiella and Enterobacter isolates were susceptible (MIC 90 ≤1.0µgm/ml). However MDR isolates of Acinetobacter spps. showed reduced susceptibility to tigecycline (64.28% sensitive) with MIC 90 of 2.0µgm/ml. 86.66% P.aeruginosa isolates were resistant to tigecycline. Interpretation & conclusions: This study shows that tigecycline can be a useful reserve antibiotic against MDR MRSA and ESBL producing Enterobacteriaceae, but a higher prevalence of resistance is seen among members of Acinetobacter spp and P.aeruginosa. Clinicians should however look out for adverse effects associated with tigecycline such as acute pancreatitis, severe nausea, vomiting and septic shock.
In vitro activity of tigecycline against local clinical isolates of some Enterobacteriaceae
Zagazig Journal of Pharmaceutical Sciences, 2020
Infectious diseases that Enterobacteriaceae cause are spreading on a wide scale. Examples of these infections are gastrointestinal tract infections, meningitis, pneumonia, septicemia, urinary tract infections, and wound infections. Antibiotic resistance among Enterobacteriaceae is a critical problem that makes treatment difficult. Tigecycline is a broad spectrum antibiotic that is effective against multi-drug resistant organisms (MDR) and may be beneficial in the therapy of infections caused by Enterobacteriaceae. This study aims to evaluate the in vitro activity of tigecycline against clinical isolates of Enterobacteriaceae species and detect the possible resistance mechanisms of them against βlactams. The sensitivity of different isolates to antibiotics was determined by standard disc diffusion method. Phenotypic detection of resistance mechanisms such as extended spectrum β-lactamase (ESBL), AmpC, ESBL& AmpC co-producers and metallo β-lactamase (MBL) β-lactamases enzymes producer isolates was investigated. A total of eighty three Enterobacteriaceae clinical isolates were collected. The common bacteria isolated were Escherichia coli and Klebsiella pneumoniae. Multidrug resistance was found in 59.04% of tested isolates. The isolates were resistant to sulfamethoxazole-trimethoprim, ciprofloxacin, tetracycline and impenem. The highest resistance was found to sulfamethoxazoletrimethoprim followed by ciprofloxacin, tetracycline and imipenem. Phenotypic detection of resistance mechanisms revealed that 69.4% of clinical isolates were ESBL producers, 12.2% were AmpC producers, and 8.2% were ESBL and AmpC co-producers, while 10.2% were MBL producers. There was no resistance found to tigecycline among all Enterobacteriaceae isolates tested. This study showed that tigecycline has potent in vitro activity against ESBL, AmpC, combined ESBL and AMPC and MBL β-lactamases producing Enterobacteriaceae.