Efficacy and Safety of Tigecycline for Patients with Hospital-Acquired Pneumonia

Xu, Li; Wang, Yali; Du, Shuai; Chen, Lin; Long, Lihui; Wu, Yan

doi:10.1159/000445425

Cited by 25 publications

(10 citation statements)

References 26 publications

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“…Other systematic analysis indicated more AEs with HD tigecycline. [51] Nausea, vomiting, diarrhea are still the most common AEs, [40,52] nevertheless, reports on tigecycline related coagulopathy and hypofibrinogenemia are increasing; [53–55] Tigecycline could change series of coagulation parameters, including prolonged prothrombin time, activated partial thromboplastin time, thrombin time, and decreased fibrinogen, especially obvious in patients receiving higher dose. [56–59] Tigecycline induced coagulation disorders usually could be reversed after promptly discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of high-dose tigecycline for the treatment of infectious diseases

Gong

Shang

et al. 2019

Medicine

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Background:High-dose (HD) tigecycline regimen is increasingly used in infectious diseases, however its efficacy and safety versus low-dose (LD) is still unclear.Methods:A systematic review and meta-analysis was performed; PubMed, Embase, Cochrane Library, ScienceDirect, Web of Science, clinicalTrials.gov, Wanfang, VIP, and China National Knowledge Infrastructure (CNKI), were searched using terms “tigecycline” AND “dose” up to October 31, 2018. Eligible studies were randomized trials or cohort studies comparing mortality, clinical response, microbiological eradication and safety of different tigecycline dose regimens for any bacterial infection. The primary outcome was mortality, and the secondary outcomes were clinical response rate, microbiological eradiation rate and adverse events (AEs). Meta-analysis was done with random-effects model, with risk ratios (RR) and 95% confidence intervals (CI) calculated for all outcomes.Results:Of 951 publications retrieved, 17 studies (n = 1041) were pooled in our meta-analysis. The primary outcome was available in 11 studies, and the RR for mortality was 0.67 (95% CI 0.53–0.84, P < .001). Clinical response (RR 1.46, 95% CI 1.30–1.65, P < .001) and microbiological eradication rate (RR 1.61, 95% CI 1.35–1.93, P < .001) were both higher in HD than in LD tigecycline regimen. However, non-Chinese study subgroup presented no statistical significance between HD and LD regimen, RR for mortality, clinical response and microbiological eradication were 0.79 (95% CI 0.56–1.14, P = .21), 1.35 (95% CI 0.96–1.92, P = .26), 1.00 (95% CI 0.22–4.43, P = 1.00), respectively. AEs did not differ between HD and LD tigecycline (RR 1.00, 95% CI 0.80–1.26, P = .97).Conclusion:HD tigecycline regimen reduced mortality meanwhile improved clinical efficacy and should be considered in serious infections caused by multidrug-resistant and extensively drug-resistant (MDR/XDR) bacteria.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of high-dose tigecycline for the treatment of infectious diseases

Gong

Shang

et al. 2019

Medicine

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“…Patients were included if they had at least one AB-positive blood culture and symptomatic disease (fever [> 38 °C or < 36 °C], chills, hypotension, or other symptoms); if patients had more than one episode of AB-BSI, only data from the first episode were included. Tigecycline therapy was defined as tigecycline monotherapy or tigecycline with other antibiotics (including cefoperazone/sulbactam), with tigecycline doses of at least 50 mg every 12 h (q12h) for more than 48 h [17]. Cefoperazone/sulbactam therapy was defined as cefoperazone/sulbactam monotherapy or cefoperazone/sulbactam with other antibiotics (without tigecycline), of which the dose of cefoperazone/sulbactam (cefoperazone: sulbactam, 2:1) was 1 g q6h or q8h, or 2 g q6h or q8h for more than 48 h.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Tigecycline or Cefoperazone/Sulbactam therapy for bloodstream infection due to Carbapenem-resistant Acinetobacter baumannii

Niu

Luo

et al. 2019

Antimicrob Resist Infect Control

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Background We retrospectively analyzed the effect of tigecycline and cefoperazone/sulbactam therapies on the prognosis of patients with carbapenem-resistant Acinetobacter baumannii bloodstream infection (CRAB-BSI). Methods CRAB-BSI patients receiving tigecycline therapy or cefoperazone/sulbactam therapy between January 2012 and December 2017 was enrolled, and strict exclusion criteria were followed. The 28-day mortality of patients was analyzed. The impact of cefoperazone/sulbactam therapy on prognosis was evaluated using Cox multivariate regression analysis. The 28-day mortality of patients receiving cefoperazone/sulbactam monotherapy and cefoperazone/sulbactam-based combination therapy was also compared. Results Three hundred forty eight patients with CRAB-BSI were enrolled in the study. Two hundred ten patients were included after applying the exclusion criteria. Of these, 135 patients received tigecycline therapy and 75 patients received cefoperazone/sulbactam therapy. The 28-day mortality of patients in the latter group was, significantly lower than that of the tigecycline group [29.3% vs. 51.9%; P = 0.001]. Cox multivariate regression analysis revealed that cefoperazone/sulbactam therapy exerted a protective effect on the prognosis of patients [hazard ratio 0.566, 95% confidence interval (0.342–0.940); P = 0.028]. Kaplan-Meier survival curve analysis indicated that the 28-day mortality of patients receiving cefoperazone/sulbactam therapy was lower than that of patients receiving cefoperazone/sulbactam monotherapy, but the difference was not significant (22.2% vs. 40%; P = 0.074). However, the mortality of patients receiving cefoperazone/sulbactam with imipenem/cilastatin was significantly lower than that of patients receiving cefoperazone/sulbactam monotherapy ( P = 0.048). Conclusions Patients treated with cefoperazone/sulbactam therapy had a better clinical outcome. The mortality of patients receiving cefoperazone/sulbactam with imipenem/cilastatin seems to be the lowest. Electronic supplementary material The online version of this article (10.1186/s13756-019-0502-x) contains supplementary material, which is available to authorized users.

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“…Tigecycline, a recently developed third-generation tetracycline antibiotic belonging to the glycylcycline class is one of the few therapeutic options for treating infections caused by A. baumannii and most carbapenem-resistant bacteria. Indications include hospital-acquired pneumonia and blood-stream infections (BSI) caused by Klebsiella pneumoniae 29,30 and nosocomial urinary tract, pulmonary, abdominal, surgical site, and bloodstream infections caused by carbapenem-resistant Enterobacteriaceae (CRE). 31 Another class of AMR identified in our study were fluoroquinolones.…”

Section: Discussionmentioning

confidence: 99%

A glimpse of antimicrobial resistance gene diversity in kefir and yoghurt

Tóth

Csabai

Maróti

et al. 2020

Preprint

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Antimicrobial resistance (AMR) is a global threat gaining more and more practical significance every year. The protection of bacteria against antimicrobials based on antimicrobial resistance genes (ARGs) developed in evolution. One of the essential clinical questions is the origin of ARGs of pathogen bacteria. Since the bacteria can share genetic components by horizontal gene transfer (HGT), all even non-pathogen bacteria may provide ARG to any pathogens when they became close physically. The bacteria of the human gut may make contact with bacteria entered into the body by food. The fermented food contains bacteria in high amount by its nature. Here we studied the diversity of ARG content by a unified metagenomic approach in various kefir and yoghurt products, in grain and isolated bacterial strains. We found numerous ARGs of commonly used fermenting bacteria with diversity characteristics in kefir and yoghurt samples. Even with the strictest filter restrictions we identified ARGs undermining the efficacy of aminocoumarin, aminoglycoside, carbapenem, cephalosporin, cephamycin, diaminopyrimidine, elfamycin, fluoroquinolone, fosfomycin, glycylcycline, lincosamides, macrolide, monobactam, nitrofuran, nitroimidazole, penam, penem, peptide, phenicol, rifamycin, tetracycline and triclosan. In the case of gene lmrD, we detected genetic environment providing mobility of this ARG. Our findings support that theory during the fermentation process the food ARG content can grow by the bacteria multiplication. Results presented suggest that starting culture strains of fermented food should be monitored and selected to decrease the ARG amount intake by nutrition.

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Efficacy and Safety of Tigecycline for Patients with Hospital-Acquired Pneumonia

Cited by 25 publications

References 26 publications

Efficacy and safety of high-dose tigecycline for the treatment of infectious diseases

Efficacy and safety of high-dose tigecycline for the treatment of infectious diseases

Comparison of Tigecycline or Cefoperazone/Sulbactam therapy for bloodstream infection due to Carbapenem-resistant Acinetobacter baumannii

A glimpse of antimicrobial resistance gene diversity in kefir and yoghurt

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