ABSTRACT
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 >or=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). CONCLUSION: TIG represents a promising option in infections from MDR pathogens, however, further clinical experience is required.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacterial Infections/drug therapy , Minocycline/analogs & derivatives , Acinetobacter Infections/drug therapy , Acinetobacter Infections/epidemiology , Acinetobacter baumannii/drug effects , Adult , Aged , Analysis of Variance , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacology , Bacteremia/drug therapy , Chi-Square Distribution , Cross Infection/drug therapy , Female , Gram-Negative Bacterial Infections/epidemiology , Humans , Klebsiella Infections/drug therapy , Klebsiella Infections/epidemiology , Klebsiella pneumoniae/drug effects , Logistic Models , Male , Microbial Sensitivity Tests , Middle Aged , Minocycline/adverse effects , Minocycline/pharmacology , Minocycline/therapeutic use , Pneumonia, Ventilator-Associated/drug therapy , Retrospective Studies , Shock, Septic/drug therapy , Surgical Wound Infection/drug therapy , TigecyclineABSTRACT
Site-specific, risk-adjusted incidence rates of intensive care unit (ICU)-acquired infections were obtained through standardized surveillance in 8 ICUs in Greece. High rates were observed for central line-associated bloodstream infection (12.1 infections per 1,000 device-days) and ventilator-associated pneumonia (12.5 infections per 1,000 device-days). Gram-negative microorganisms accounted for 60.4% of the isolates recovered, and Acinetobacter species were predominant. To reduce infection rates in Greek ICUs, comprehensive infection control programs are required.