Efficacy and safety of tigecycline for the treatment of severe infectious diseases: an updated meta-analysis of RCTs

Shen, Fu‐Ming; Han, Qianpeng; Xie, Di; Fang, Ming; Zeng, Hongke; Deng, Yiyu

doi:10.1016/j.ijid.2015.08.009

Cited by 63 publications

(50 citation statements)

References 39 publications

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“…Other large of studies of CRE bacteremia and severe sepsis have demonstrated that inadequate empirical antimicrobial therapy is independently associated with increased mortality (8,(26)(27)(28)(29). In addition to this potential confounder of illness severity, it is also possible that the limitations of the empirical CRE-active agents most commonly used in this study (polymyxins and tigecycline) diminished the benefit of providing active empirical therapy (30)(31)(32).…”

Section: Discussionmentioning

confidence: 90%

“…Both agents have suboptimal clinical efficacies and unfavorable pharmacokinetic-pharmacodynamic profiles, and the polymyxins are highly nephrotoxic (30)(31)(32). Ceftazidime-avibactam was approved in the United States in 2015 as the first ␤-lactam/␤-lactamase inhibitor combination with in vitro activity against KPC-producing Enterobacteriaceae.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multicenter Clinical and Molecular Epidemiological Analysis of Bacteremia Due to Carbapenem-Resistant Enterobacteriaceae (CRE) in the CRE Epicenter of the United States

Satlin

Chen

Patel

et al. 2017

Antimicrob Agents Chemother

201

158

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Although the New York/New Jersey (NY/NJ) area is an epicenter for carbapenem-resistant Enterobacteriaceae (CRE), there are few multicenter studies of CRE from this region. We characterized patients with CRE bacteremia in 2013 at eight NY/NJ medical centers and determined the prevalence of carbapenem resistance among Enterobacteriaceae bloodstream isolates and CRE resistance mechanisms, genetic backgrounds, capsular types (cps), and antimicrobial susceptibilities. Of 121 patients with CRE bacteremia, 50% had cancer or had undergone transplantation. The prevalences of carbapenem resistance among Klebsiella pneumoniae, Enterobacter spp., and Escherichia coli bacteremias were 9.7%, 2.2%, and 0.1%, respectively. Ninety percent of CRE were K. pneumoniae and 92% produced K. pneumoniae carbapenemase (KPC-3, 48%; KPC-2, 44%). Two CRE produced NDM-1 and OXA-48 carbapenemases. Sequence type 258 (ST258) predominated among KPC-producing K. pneumoniae (KPC-Kp). The wzi154 allele, corresponding to cps-2, was present in 93% of KPC-3-Kp, whereas KPC-2-Kp had greater cps diversity. Ninety-nine percent of CRE were ceftazidime-avibactam (CAZ-AVI)-susceptible, although 42% of KPC-3-Kp had an CAZ-AVI MIC of Ն4/4 g/ml. There was a median of 47 h from bacteremia onset until active antimicrobial therapy, 38% of patients had septic shock, and 49% died within 30 days. KPC-3-Kp bacteremia (adjusted odds ratio [aOR], 2.58; P ϭ 0.045), cancer (aOR, 3.61, P ϭ 0.01), and bacteremia onset in the intensive care unit (aOR, 3.79; P ϭ 0.03) were independently associated with mortality. Active empirical ther-

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Multicenter Clinical and Molecular Epidemiological Analysis of Bacteremia Due to Carbapenem-Resistant Enterobacteriaceae (CRE) in the CRE Epicenter of the United States

Satlin

Chen

Patel

et al. 2017

Antimicrob Agents Chemother

201

158

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“…Tigecycline evades the Tet(A) to Tet(E) efflux pumps and ribosome protection mechanisms that cause most tetracycline resistance, but its utility as monotherapy is compromised by (i) disputed breakpoints for Enterobacteriaceae (U.S. Food (ii) a lack of breakpoints for Acinetobacter baumannii, (iii) low serum drug peaks, and (iv) an FDA warning of excess mortality (1)(2)(3)(4)(5). Despite these concerns, case series suggest that patients with severe CPE infections respond better to colistin-tigecycline combinations than to colistin alone (6,7).…”

mentioning

confidence: 99%

In Vitro Activity of Eravacycline against Carbapenem-Resistant Enterobacteriaceae and Acinetobacter baumannii

Livermore

Mushtaq

Warner

et al. 2016

Antimicrob Agents Chemother

130

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b Eravacycline and comparators were tested against carbapenem-and tigecycline-resistant Enterobacteriaceae and Acinetobacter isolates received at the United Kingdom's national reference laboratory. Eravacycline MICs correlated closely with those of tigecycline but mostly were around 2-fold lower; both molecules retained full activity against isolates with high-level tetracycline and minocycline resistance. MIC 90 s of eravacycline and tigecycline were raised ca. 2-fold for carbapenem-resistant Enterobacteriaceae compared with carbapenem-susceptible controls, probably reflecting subsets of isolates with increased efflux.

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“…El análisis de la información de los 9 metaanálisis [20][21][22][23][24][25][26][27][28] que incluyeron 5 estudios clínicos aleatorizados con 1873 pacientes, y de ellos 952 asignados al brazo de tigeciclina, la cual no mostró inferioridad frente a los comparadores en estos desenlaces, excepto para eventos adversos en donde el grupo de tigeciclina presento mayor incidencia (tabla 3).…”

Section: Clase Interpretación Clínicaunclassified

Tigeciclina en infecciones de piel y tejidos blandos complicadas.

Rodríguez¹,

Valderrama

Roncancio-Villamil

et al. 2017

Infect

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ResumenObjetivo: evaluar la mejor evidencia actual disponible para generar recomendaciones con respecto a la efectividad y seguridad del uso de tigeciclina en adultos con infección de piel y tejidos blandos (IPTB). Materiales y métodos: se realizó una revisión sistemática de la literatura, seleccionando los metaanálisis y experimentos clínicos controlados (ECCs), los cuales se valoraron utilizando la herramienta SIGN (Scottish Intercollegiate Guidelines Network.), con el fin de generar tablas de evidencia según GRADE de los estudios de tigeciclina en la indicación de IPTB, para posteriormente utilizar un proceso Delphi modificado para calificar las diferentes recomendaciones. Resultados: la revisión sistemática se incluyeron 9 metaanálisis que incluyeron 5 estudios clínicos aleatorizados con 1873 pacientes, y de ellos 952 asignados al brazo de tigeciclina, no mostró inferioridad frente a los comparadores en curación clínica (RR= 0.76 IC95% 0,57 -1.03), curación microbiológica (RR= 0.92 IC95% 0,61 -1.38), eventos adversos serios RR 1,41 (IC95%0,97 a 2,35), ni mortalidad RR 1,9 (IC95%0,84 a 4,3). La tigeciclina puede relacionarse con mayor frecuencia de eventos adversos leves de origen gastrointestinal. Conclusión: en pacientes adultos con IPTB, se considera que el uso de tigeciclina en monoterapia en pacientes no críticamente enfermos es equivalente en eficacia a otras opciones terapéuticas antimicrobianas. Se debe considerar especialmente como terapia de ajuste en pacientes con infecciones polimicrobianas.Palabras claves: Tigeciclina, metaanálisis, infección de piel y tejidos blandos, infecciones bacterianas de la piel. Tigecycline in complicated skin and soft-tissue infection AbstractObjective: To assess current best evidence available to generate recommendations regarding the effectiveness and safety of tigecycline use in adults with skin and soft-tissue infections (SSTIs). Materials and methods: A systematic review of the literature was conducted by selecting meta-analyzes and controlled clinical trials (CCTs), which were assessed using the SIGN tool (Scottish Intercollegiate Guidelines Network) in order to generate evidence tables according to GRADE of studies of tigecycline in the SSTIs indication, and then using a modified Delphi Method to score the different recommendations. Results: Nine meta-analyzes were included compounded by five randomized clinical trials with a sample size of 1873 patients, where 952 patients were assigned to tigecycline. The group of patients with tigecycline showed no inferiority to the comparator in clinical cure (RR = 0.76 95% CI 0.57 -1.03), microbiologic cure (RR = 0.92 95% CI 0.61 -1.38), serious adverse events RR 1, 41 (95% CI 0.97 to 2.35) or mortality RR 1.9 (95% CI 0.84 to 4.3). Tigecycline may be related to increased frequency of minor adverse events of gastrointestinal origin. Conclusion: In adult patients with SSTIs, it is considered that the use of tigecycline in monotherapy in non-critically ill patients is equivalent in effectiveness to other antimicrobial treatmen...

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Efficacy and safety of tigecycline for the treatment of severe infectious diseases: an updated meta-analysis of RCTs

Abstract: Tigecycline is not as effective as other antibiotics with relatively more frequency of adverse events and higher mortality rate.

Cited by 63 publications

References 39 publications

Multicenter Clinical and Molecular Epidemiological Analysis of Bacteremia Due to Carbapenem-Resistant Enterobacteriaceae (CRE) in the CRE Epicenter of the United States

Multicenter Clinical and Molecular Epidemiological Analysis of Bacteremia Due to Carbapenem-Resistant Enterobacteriaceae (CRE) in the CRE Epicenter of the United States

In Vitro Activity of Eravacycline against Carbapenem-Resistant Enterobacteriaceae and Acinetobacter baumannii

Tigeciclina en infecciones de piel y tejidos blandos complicadas.

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