High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii in Intensive Care Unit
Authors Bai XR, Jiang DC, Yan SY
Received 11 February 2020
Accepted for publication 21 April 2020
Published 18 May 2020 Volume 2020:13 Pages 1447—1454
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Suresh Antony
Xiang-Rong Bai,1,2 De-Chun Jiang,1,2 Su-Ying Yan1,2
1Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China; 2National Clinical Research Center for Geriatric Disorder, Beijing, People’s Republic of China
Correspondence: De-Chun Jiang Email email@example.com
Purpose: The association between clinical and microbiological outcomes and high-dose tigecycline (TGC) was assessed in elderly (≥ 60 years old) patients with hospital-acquired and ventilator-associated pneumonia due to multidrug-resistant Acinetobacterbaumannii(A. baumannii). This study also assessed tigecycline combination with different antibiotics and its influence on the outcome.
Patients and Methods: An observational retrospective cohort study was conducted. Patients over 60 years old were treated with standard-dose (SD) TGC (100-mg intravenous TGC initially, followed by 50-mg doses administered intravenously twice daily) and high-dose (HD) TGC (200-mg intravenous TGC initially, followed by 100-mg doses administered intravenously twice daily) for a microbially confirmed infection. The outcome was 30-day crude mortality, co-administered antimicrobial agent and the microbial eradication percentage in both groups.
Results: A total of 48 multidrug-resistant A. baumannii respiratory patients were identified. Tigecycline was administered to 85% of ventilation-associated pneumonia (VAP) patients (28/33) in the SD group and 80% of VAP patients (12/15) in the HD group. Combined therapy was the major treatment option in both groups, accounting for 85% and 87%, respectively. Median treatment duration in both groups was 7.36 vs 8.6 days, respectively. Survival days were 13.61 vs 12.4 days (P=0.357), respectively. The 30-day crude mortality was 39.4% (13/33) for the SD group and 14% (2/15) for the HD group (P=0.098). The microbial eradication rate of respiratory specimens in the SD group was higher than that in the HD group (P=0.02). The variables associated with 30-day crude mortality were chronic obstructive pulmonary disease (hazard ratio [HR] 11.63, 95% CI 1.094– 123.058; P=0.042), tigecycline treatment duration (HR 0.690, 95% CI 0.515– 0.926; P=0.013), and surgery before infection (HR 79.276, 95% CI 6.983– 899.979; P=0.000). High-dose tigecycline was not associated with 30-day crude mortality (adjusted HR 0.329, 95% CI 0.074– 1.460; P=0.145). Combined antibiotics was also not different between the two groups.
Conclusions: High-dose tigecycline was not associated with 30-day crude mortality in elderly patients with pneumonia due to multidrug-resistant A. baumannii, although the microbial eradication rate was high.
Keywords: pneumonia, critical ill patients, high-dose tigecycline, drug-resistant, Acinetobacter baumannii
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]