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
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.