Clinical Experience with Tigecycline in the Treatment of Prosthetic Joint Infections

Abstract

Background As the population in the United States ages, the number of people who will require a joint arthroplasty is expected to rise dramatically. The most serious complication of this surgery is prosthetic joint infection (PJI) which can lead to long-term morbidity and even mortality. Biofilms play a major role in these infections, and studies have suggested that tigecycline may work better than other antimicrobials in the setting of biofilms. In this study, we examined our institution’s experience with using tigecycline to treat PJI.Methods This was a retrospective review of all adult patients with PJI treated at West Virginia University from January 2008 to March 2016 who received tigecycline for 50% or greater of the treatment course. Demographic data, rationale for tigecycline use, type of surgery, microbiologic data, outcome and complications were assessed. Failure was defined as need to return to the operating room for an infectious complication or persistent drainage from the joint.ResultsIn total, 34 patients met inclusion criteria. The median age was 65 years, and 62% of the patients were female. The most common reason for tigecycline use was empiric therapy, but other reasons included antimicrobial allergies and resistant organisms. The antimicrobial was used as frontline therapy in 29 cases (85%), and the mean duration of tigecycline therapy was 38 days. The most common organisms isolated were methicillin resistant Staphylococcus aureus (n = 7), coagulase negative Staphylococci (n = 5), and Enterococcus species (n = 4), but 12 cases (35%) were culture negative. Treatment success was documented for 21 cases (62%); though, there was limited follow-up (2 months or less) in four of the successful cases. Nausea and vomiting was the most common adverse event, occurring in three patients.Conclusion Tigecycline is a glycylcycline approved for use in a variety of infections including intra-abdominal and skin soft-tissue infections, but little is known about its use in the treatment of PJI. We found that tigecycline is well tolerated even when given for 6 weeks duration. Twenty-one of the 34 patients (62%) met our definition of successful treatment outcome with tigecycline. More studies are needed to assess tigecycline’s use in the treatment of PJI.Disclosures All authors: No reported disclosures.

Spontaneous Knee Hemarthrosis Due to Hypofibrinogenemia Following Tigecycline Treatment for Periprosthetic Joint Infection

“…Its use has been approved by the Food and Drugs Administration (FDA) and the European Medicines Agency (EMA) for complicated intra-abdominal infections, community-acquired pneumonia by sensitive bacteria, and complicated skin and soft tissue infections. However, tigecycline has recently been used in the treatment of periprosthetic joint infections [5][6]. Treating periprosthetic joint infections is a challenge because of the presence of a microbial biofilm.…”