Carbapenems vs tigecycline for the treatment of complicated intra-abdominal infections

Chen, Lingyuan; Liang, Xueqing; Jiang, Junsong; Xian-shu, LI; Li, Yan

doi:10.1097/md.0000000000017436

Cited by 11 publications

(5 citation statements)

References 48 publications

(56 reference statements)

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“…From the point of this view, both tigecycline and meropenem are feasible in the treatment of postoperative cIAIs of abdominal tumor patients. A Bayesian network meta-analysis of randomized clinical trials showed that on differences in clinical and microbiological outcomes and mortality observed between meropenem and tigecycline (21), which supported our conclusion.…”

Section: Discussionsupporting

confidence: 85%

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

Wang

Xing

et al. 2021

Ann Palliat Med

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Background: The efficacy and safety of tigecycline in the treatment of complicated intra-abdominal infections (cIAIs) is potentially controversial. Here we conducted the non-inferiority study to assess the efficacy and safety of tigecycline versus meropenem in the treatment of postoperative cIAIs.Methods: Data of abdominal tumor surgery patients with postoperative cIAIs admitted to intensive care unit (ICU) between October 2017 and December 2019 were collected. A prospective, randomized controlled trial was conducted in which 56 eligible patients with cIAIs randomly received intravenous tigecycline or meropenem for 3 to 14 days. Patients and clinicians were not blinded to the group allocation.Results: The total of 56 patients were enrolled, which were divided into 2 groups, one group included 30 patients receiving meropenem and another group included 26 receiving tigecycline therapy. The 2 groups were similar at demographic and baseline clinical characteristics. Microorganisms were isolated from 46 of 56 patients (82.14%), with a total of 107 pathogens were cultured in two groups. The two groups had similar distribution of infecting microorganisms. The primary end point was the clinical response at the end-oftherapy (EOT) visit and upon discharge visit and comprehensive efficacy. The clinical success rates were 83.33%, 76.67% for meropenem versus 76.92%, 88.46% for tigecycline at the EOT visit and upon discharge visit (P>0.05), respectively. Comprehensive efficacy did not significantly differ between two groups either. There were no significant differences in 30-day and 60-day all-cause mortality between two groups (P>0.05).The univariable analysis identified that serum albumin at admission ICU, colorectal cancer on oncology type, postoperative abdominal bleeding were the risk factors for 60-day all-cause mortality. The multivariable analysis showed that postoperative abdominal bleeding were independent predictors of 60-day all-cause mortality. Gastrointestinal disorders and antibacterials-induced Fungal Infection were the most frequently reported adverse events (AEs). The incidence of AEs was similar between meropenem and tigecycline groups (P>0.05). Conclusions:Taken together, the study demonstrated that tigecycline is as effective and safe as meropenem for postoperative cIAIs in abdominal tumors patients. Tigecycline is non-inferior to meropenem.

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Section: Discussionsupporting

confidence: 85%

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

Wang

Xing

et al. 2021

Ann Palliat Med

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“…The comparison of carbapenems and tigecycline in our pairwise meta-analysis was of borderline signi cance, but no signi cant difference was observed in the NMA. A Bayesian metaanalysis of 15 studies comparing the effectiveness of individual carbapenems versus tigecycline showed consistent results (29). Thus, the borderline signi cance result in our study should be interpreted conservatively (30).…”

Section: Discussionsupporting

confidence: 54%

“…Our ndings re ect the real-time and supplementary evidence regarding the e cacy and safety of tigecycline compared with other regimens for cIAI treatment. Indeed, other studies have shown higher rates of adverse events in patients treated with tigecycline relative to those treated with comparators (29,33). Nevertheless, tigecycline remains an important treatment option for patients suspected of have an infection with an antibiotic-resistant pathogen (1,34,35).…”

Section: Discussionmentioning

confidence: 99%

Efficacy, safety, and tolerability of antimicrobial agents for complicated intra- abdominal infection: a systematic review and network meta-analysis

Kong¹,

Deng

Li³

et al. 2023

Preprint

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Background Which antimicrobial agents provide the optimal efficacy, safety, and tolerability for the empirical treatment of complicated intra-abdominal infection (cIAI) remains unclear but is paramount in the context of evolving antimicrobial resistance. Therefore, updated meta-analyses on this issue are warranted. Methods We systematically searched 4 major electronic databases from their inception through October 2022. Randomized controlled trials examining antimicrobial agents for cIAIs treatment were included. Two reviewers independently assessed the quality of included studies utilizing the Cochrane Collaboration’s risk of bias tool as described in Cochrane Collaboration Handbook and extracted data from all manuscripts according to a predetermined list of interests. All meta-analyses were conducted using R software. The primary outcome was clinical success rate in patients with cIAI. Results Forty-five active-controlled trials with low to medium methodological quality and involving 14,267 adults with cIAI were included in network meta-analyses. The vast majority of patients with an APACHE II score < 10 had low risk of treatment failure or death. Twenty-one regimens were investigated. In the network meta-analyses, cephalosporin-based regimens were more effective and better tolerated than tigecycline with regard to clinical success rate (odds ratio [OR] = 1.3, 95% confidence interval [CI] 1.00 ~ 1.70) and discontinuation due to adverse events (OR = 0.69, 95% CI 0.44 ~ 1.00). No statistically significant differences were found among antimicrobial agents regarding microbiological success rates and all-cause mortality. A statistically significant trend was observed favoring carbapenems, which exhibited fewer discontinuations because of adverse events when compared with tigecycline (OR = 0.66, 95% CI 0.42 ~ 1.00). In pairwise meta-analyses, compared with tigecycline, carbapenems (2,315 participants, OR = 1.32, 95% CI 1.00 ~ 1.75, I2 = 24.0%) were associated with superior clinical success rate. These results were of borderline statistical significance. Compared with tigecycline, carbapenems (2,304 participants, OR = 0.67, 95% CI 0.45 ~ 0.91; I2 = 48.5%) were associated with significantly reduced risk of serious adverse events. According to the surface under the cumulative ranking curve analysis, cephalosporin-based regimens were more likely to be optimal among all treatments in terms of efficacy, and tigecycline was more likely to be worst regimen in terms of safety and tolerability. Conclusion This study suggests that cephalosporin-based regimens are optimal for the empiric treatment of patients with cIAIs and that tigecycline should be prescribed cautiously considering safety and tolerability concerns. However, it should be noted that data currently available for antimicrobial agent’ effectiveness, safety, and tolerability pertain mostly to lower-risk patients with cIAIs.

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“…Our findings reflect real-time and supplementary evidence regarding the efficacy and safety of tigecycline compared with other regimens for cIAI treatment. Indeed, other studies have shown higher rates of AEs in patients treated with tigecycline relative to other treatments[ 32 , 33 ]. Nevertheless, tigecycline remains an important treatment option for patients suspected of being infected with an antibiotic-resistant pathogen [ 1 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy, safety, and tolerability of antimicrobial agents for complicated intra-abdominal infection: a systematic review and network meta-analysis

Kong

Deng

et al. 2023

BMC Infect Dis

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Background Which antimicrobial agents provide the optimal efficacy, safety, and tolerability for the empirical treatment of complicated intra-abdominal infection (cIAI) remains unclear but is paramount in the context of evolving antimicrobial resistance. Therefore, updated meta-analyses on this issue are warranted. Methods We systematically searched four major electronic databases from their inception through October 2022. Randomized controlled trials examining antimicrobial agents for cIAI treatment were included. Two reviewers independently assessed the quality of included studies utilizing the Cochrane Collaboration’s risk of bias tool as described in the updated version 1 of the Cochrane Collaboration Handbook and extracted data from all manuscripts according to a predetermined list of topics. All meta-analyses were conducted using R software. The primary outcome was clinical success rate in patients with cIAIs. Results Forty-five active-controlled trials with low to medium methodological quality and involving 14,267 adults with cIAIs were included in the network meta-analyses. The vast majority of patients with an acute physiology and chronic health evaluation II score < 10 had low risk of treatment failure or death. Twenty-one regimens were investigated. In the network meta-analyses, cefepime plus metronidazole was more effective than tigecycline and ceftolozane/tazobactam plus metronidazole (odds ratio [OR] = 1.96, 95% credibility interval [CrI] 1.05 ~ 3.79; OR = 3.09, 95% CrI 1.02 ~ 9.79, respectively). No statistically significant differences were found among antimicrobial agents regarding microbiological success rates. Cefepime plus metronidazole had lower risk of all-cause mortality than tigecycline (OR = 0.22, 95% CrI 0.05 ~ 0.85). Statistically significant trends were observed favoring cefotaxime plus metronidazole, which exhibited fewer discontinuations because of adverse events (AEs) when compared with eravacycline, meropenem and ceftolozane/tazobactam plus metronidazole (OR = 0.0, 95% CrI 0.0 ~ 0.8; OR = 0.0, 95% CrI 0.0 ~ 0.7; OR = 0.0, 95% CrI 0.0 ~ 0.64, respectively). Compared with tigecycline, eravacycline was associated with fewer discontinuations because of AEs (OR = 0.17, 95% CrI 0.03 ~ 0.81). Compared with meropenem, ceftazidime/avibactam plus metronidazole had a higher rate of discontinuation due to AEs (OR = 2.09, 95% CrI 1.0 ~ 4.41). In pairwise meta-analyses, compared with ceftriaxone plus metronidazole, ertapenem and moxifloxacin (one trial, OR = 1.93, 95% CI 1.06 ~ 3.50; one trial, OR = 4.24, 95% CI 1.18 ~ 15.28, respectively) were associated with significantly increased risks of serious AEs. Compared with imipenem/cilastatin, tigecycline (four trials, OR = 1.57, 95%CI 1.07 ~ 2.32) was associated with a significantly increased risk of serious AEs. According to the surface under the cumulative ranking curve, Cefepime plus metronidazole was more likely to be optimal among all treatments in terms of efficacy and safety, tigecycline was more likely to be worst regimen in terms of tolerability, and eravacycline was more likely to be best tolerated. Conclusion This study suggests that cefepime plus metronidazole is optimal for empirical treatment of patients with cIAIs and that tigecycline should be prescribed cautiously considering the safety and tolerability concerns. However, it should be noted that data currently available on the effectiveness, safety, and tolerability of antimicrobial agents pertain mostly to lower-risk patients with cIAIs.

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Carbapenems vs tigecycline for the treatment of complicated intra-abdominal infections

Abstract: Supplemental Digital Content is available in the text

Cited by 11 publications

References 48 publications

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

Efficacy, safety, and tolerability of antimicrobial agents for complicated intra- abdominal infection: a systematic review and network meta-analysis

Efficacy, safety, and tolerability of antimicrobial agents for complicated intra-abdominal infection: a systematic review and network meta-analysis

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