Background Acinetobacter baumannii has become an important hospital-acquired pathogen. With the rise in antibiotic resistance, tigecycline has been used frequently against multidrug-resistant acinetobacter baumannii (MRAB).

Purpose To analyse the use of tigecycline after an outbreak of MRAB in a third-level hospital.

Material and methods Retrospective observational study performed from January to March 2017 in a general hospital of 330 beds. All patients who were treated with tigecycline during the study period were included. The adequacy of antibiotic treatment was analysed, including the following variables: demographic, responsible service, antibiotic dosage, duration of treatment, sample for microbiological culture, indication of treatment and mortality during admission. Clinical data were obtained from computerised medical records (Selene^®). Data on tigecycline consumption were also collected during the study period.

Results Twenty-one patients were treated with tigecycline, with a mean age of 70.6±17.8 years: 66.6% were males. Fourteen patients (66.6%) were admitted to the Infectious Diseases Section, six patients (28.6%) to the Intensive Care Unit and one patient (4.8%) to anaesthesia and reanimation. Nine patients(42.9%) received high doses of tigecycline (200 mg loading dose, followed by 100 mg every 12 hours), while 12 patients (57.1%) received standard dose (100 mg loading dose, followed by 50 mg every 12 hours). The mean duration of treatment was 9.7±6.2 days. In 10 patients (47.6%) MRAB were isolated in sputum, in seven (33.4%) in bronchial aspirate and two patients (9.5%) in wound exudate. In two patients (9.5%) no culture with MRAB was found.

In five patients (23.8%) tigecycline use was not indicated (colonisation in three patients (60%), or no culture available in two (40%)). Overall mortality was 61.9% (13 patients). The subgroup treated with high dose showed a mortality of 66.6% (six patients out of nine), while the subgroup treated with the standard dose showed a mortality of 58.4% (seven patients out of 12). Finally, the economic expenditure on tigecycline during the study period was €43,000, founding no consumption the same period of the previous year.

Conclusion The use of tigecycline at high doses for MRAB infections is controversial, especially in patients with colonisation. Outbreaks have a high economic and clinical impact, so the evaluation before starting treatment could optimise economic resources.

No conflict of interest