Case-Control Study of the Risk Factors for Acquisition of Pseudomonas and Proteus Species during Tigecycline Therapy

Abstract

bTigecycline is an important agent in clinical practice because of its broad-spectrum activity. However, it has no activity against Pseudomonas or Proteus species. We conducted a case-control study to analyze risk factors for the acquisition of Pseudomonas or Proteus spp. during tigecycline therapy. Placement of suction drainage at infected wound sites, ICU stay, and neurologic disease were identified as independent risk factors for the acquisition of Pseudomonas and Proteus spp. Over the past 2 decades, there has been a rapid emergence of multidrug-resistant organisms, which is a major problem in terms of infection control. There is a crucial need for new antibiotics because of the limited treatment options for infections caused by these organisms (1-3). Tigecycline, one of the glycylcycline antibiotics, was designed to overcome resistance mechanisms mediated by efflux pump and ribosomal protection. It has broad-spectrum activity that includes activity against antibioticresistant bacteria (4-6). However, the U.S. Food and Drug Administration noted that, in a pooled analysis of 13 clinical trials, tigecycline was significantly associated with an increased risk for all-cause mortality compared to that of other antibiotics used to treat serious infections and announced that it has added a boxed warning about the increased risk for death to the label of tigecycline (7). Nevertheless, the unique spectrum of activity and favorable postantibiotic effect make tigecycline an important antibiotic in clinical practice (1-3, 8-10), particularly for complicated skin and soft tissue infections and the complicated intra-abdominal infections for which it is indicated (1,3,8,10). However, as tigecycline has no activity against Pseudomonas and Proteus species, there are concerns about the possibility of superinfection caused by these organisms (11,12). We aimed to analyze risk factors for acquisition of Pseudomonas and Proteus spp., organisms intrinsically resistant to tigecycline.A retrospective case-control study was performed to identify risk factors for acquisition of Pseudomonas and Proteus spp. during tigecycline therapy. Clinical and microbiological data were collected from administrative, pharmacy, and laboratory computerized databases in our hospitals (Samsung Medical Information Systems). Case and control patients were selected from adult patients who received tigecycline for more than 3 days between January 2008 and April 2014 at Samsung Changwon Hospital and Samsung Medical Center (Sungkyunkwan University-affiliated hospitals). Forty-one patients whose microbiological cultures grew Pseudomonas or Proteus spp. during tigecycline therapy were designated cases. For every case, two matched controls were randomly selected from the 628 patients who received tigecycline for more than 3 days during the study period and did not have Pseudomonas or Proteus spp. isolations. Bacterial acquisition was defined as isolation of Pseudomonas or Proteus spp. from clinical specimens and classification as true infection or colonization. ...

Pancreatitis Caused by Tigecycline: A Rare Case Report

“…Tigecycline is a broad-spectrum antibiotic, obtained by modifying earlier tetracycline, to prevent resistance mechanisms and is effective against many multidrugresistant organisms [1,2]. According to the naranjo adverse drug reaction probability scale, tigacycline can cause pancreatitis during treatment [3].…”