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DI-049 Good practice on antibiotic use: tigecycline in a medical intensive care unit
  1. S Louhichi1,
  2. A Neffati2,
  3. M Dridi1,
  4. MA Yousfi1
  1. 1Tunisian Military Hospital, Pharmacy Department, Tunis, Tunisia
  2. 2Tunisian Military Hospital, Pharmacy Department/Department of Critical Care Medicine and Anaesthesiology, Tunis, Tunisia

Abstract

Background Tigecycline is an interesting therapeutic alternative in case of infections due to multidrug resistant bacteria and/or complex clinical situations. The Marketing Authorisation (MA) allows the use of tigecycline for skin and soft tissue infections and for complicated intra-abdominal infections. Its prescription must be rationalised in order to slow down the emergence of resistance. Therefore, our hospital has implemented an ‘Antimicrobial Stewardship’ (AS) programme since January 2015. It aims to organise the prescription of some precious antibiotics.

Purpose Our study aimed to judge the degree of conformity of tigecycline prescriptions with the MA criteria and to evaluate the circumstances when this antibiotic was used before the implementation of the AS strategy.

Material and methods This was a 2 year retrospective study (from 1 January 2013 to 31 December 2014) carried out in the medical intensive care unit of our hospital. The only inclusion criterion was treatment with tigecycline during this period. There were no exclusion criteria. Data collection was performed using patients’ medical files and prescriptions.

Results The total number of patients was 29. The majority were men (sex ratio (M/F)=2.22). Mean age was 52 years (range 22–82). 66% of prescriptions were outside the MA criteria and were mainly for septic shock and pneumonia (79% and 11% of total prescriptions, respectively). Tigecycline was prescribed as a firstline treatment in 15 cases (52%). High doses of this antibiotic (200 mg as a loading dose then 100 mg *2/day) were prescribed in 66% of cases. In 31% of patients, tigecycline was given for less than 72 hours and was replaced by another antibiotic based on culture and sensitivity results. 52% of infections were documented microbiologically, of which 40% were caused by Acinetobacter baumanii.

Conclusion Our results showed that tigecycline use was not appropriate in two-thirds of cases. This highlights the need to carry out more clinical trials to evaluate its effectiveness for new indications. Furthermore, usual dose of tigecycline was not respected in many cases and microbiological documentation was absent in half of the patients. Subsequent studies will show the impact of the AS strategy on antibiotic use and on the management of bacterial resistance in our institution.

No conflict of interest

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