In-vitro activity of tigecycline and comparator agents against common pathogens: Indian experience

Veeraraghavan, Balaji; Poojary, Aruna; Shankar, Chaitra; Bari, Anurag Kumar; Kukreja, S.; Thukkaram, Bhuvaneswari; Neethimohan, Ramya Gajaraj; Bakhtavachalam, Yamuna Devi; Kamat, Shweta

doi:10.3855/jidc.10376

Cited by 10 publications

(5 citation statements)

References 11 publications

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“…In the present study, in patients caused by MDR and polymicrobial infections, clinical success rate for tigecycline was significantly higher than that for meropenem at upon discharge visit, whereas there was no statistical difference. A surveillance trial about tigecycline against MDR Gram- (24). Another previously published systematic review and metaanalysis demonstrated that tigecycline combination therapy was associated with significantly lower 30-day mortality than does monotherapy (25).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Antimicrobial susceptibility of all E. coli and K. pneumoniae isolates was determined by the Kirby-Bauer disk diffusion method on Cation-Adjusted Mueller Hinton agar (Merck, Germany) and interpreted as recommended by the Clinical and Laboratory Standards Institute (2018 CLSI breakpoints) or Food and Drug Administration (FDA) breakpoints guidelines (for tigecycline) [ 18 , 19 ]. Antibiotic discs used were as follow: penicillins [piperacillin (PIP, 100 μg)], β-lactam/β-lactamase inhibitor combinations [piperacillin/tazobactam (PTZ, 100/10 μg)], cephems [ceftazidime (CAZ, 30 μg), cefotaxime (CTX, 30 μg), cefepime (FEP, 30 μg), cefpodoxime (CPD, 30 μg)], monobactams [aztreonam (ATM, 30 μg)], carbapenems [imipenem (IPM, 10 μg), meropenem (MEM, 10 μg), ertapenem (ETP, 10 μg), doripenem (DOR, 10 μg)], aminoglicosides [gentamicin(GEN,10 μg)], Amikacin (AK, 30 μg)], Fluoroquinolones [ciprofloxacin (CIP, 5 μg)], inhibitors [trimethoprim-sulfamethoxazole (TS, 2.5 μg)], fosfomycins [fosfomycin/trometamol (FOT, 200 μg)], tigecycline (TGC, 15 μg), and nalidixic acid (NA, 30 μg), (Mast Group, Merseyside, UK).…”

Section: Methodsmentioning

confidence: 99%

Molecular characteristics of antibiotic-resistant Escherichia coli and Klebsiella pneumoniae strains isolated from hospitalized patients in Tehran, Iran

Sharahi

Hashemi

Ardebili

et al. 2021

Ann Clin Microbiol Antimicrob

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Background We evaluated the distribution of carbapenem and colistin resistance mechanisms of clinical E. coli and K. pneumoniae isolates from Iran. Methods 165 non-duplicate non-consecutive isolates of K. pneumoniae and E. coli were collected from hospitalized patients admitted to Iran's tertiary care hospitals from September 2016 to August 2018. The isolates were cultured from different clinical specimens, including wound, urine, blood, and tracheal aspirates. Antibiotic susceptibility testing was performed by disc diffusion and microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) guideline. The presence of extended spectrum β-lactamases (ESBLs) genes, carbapenemase genes, as well as fosfomycin resistance genes, and colistin resistance genes was also examined by PCR-sequencing. The ability of biofilm formation was assessed with crystal violet staining method. The expression of colistin resistance genes were measured by quantitative reverse transcription-PCR (RT-qPCR) analysis to evaluate the association between gene upregulation and colistin resistance. Genotyping was performed using the multi-locus sequencing typing (MLST). Results Colistin and tigecycline were the most effective antimicrobial agents with 90.3% and 82.4% susceptibility. Notably, 16 (9.7%) isolates showed resistance to colistin. Overall, 33 (20%), 31 (18.8%), and 95 (57.6%) isolates were categorized as strong, moderate, and weak biofilm-producer, respectively. Additionally, blaTEM, blaSHV, blaCTX-M, blaNDM-1, blaOXA-48-like and blaNDM-6 resistance genes were detected in 98 (59.4%), 54 (32.7%), 77 (46.7%), 3 (1.8%), 17 (10.30%) and 3 (1.8%) isolates, respectively. Inactivation of mgrB gene due to nonsense mutations and insertion of IS elements was observed in 6 colistin resistant isolates. Colistin resistance was found to be linked to upregulation of pmrA-C, pmrK, phoP, and phoQ genes. Three of blaNDM-1 and 3 of blaNDM-6 variants were found to be carried by IncL/M and IncF plasmid, respectively. MLST revealed that blaNDM positive isolates were clonally related and belonged to three distinct clonal complexes, including ST147, ST15 and ST3299. Conclusions The large-scale surveillance and effective infection control measures are also urgently needed to prevent the outbreak of diverse carbapenem- and colistin-resistant isolates in the future.

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“…The authors concluded that tigecycline is a potential reserved drug owing to the growing drug resistance. 19…”

Section: Tigecycline—spectrum Of Activitymentioning

confidence: 99%

“…The authors concluded that tigecycline is a potential reserved drug owing to the growing drug resistance. 19 Tigecycline has been approved in the United States and Europe for the treatment of complicated skin and soft-tissue infections (cSSTI) and complicated intra-abdominal infections (cIAI) and additionally for community acquired bacteria pneumonia (CAP) in the United States. In India, tigecycline was approved for the same indications by the CDSCO in August 2006.…”

Section: Tigecycline-spectrum Of Activitymentioning

confidence: 99%

Tigecycline: Role in the Management of cIAI and cSSTI in the Indian Context

Swaminathan

Kundu

2020

Indian Journal of Clinical Medicine

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The current millennium has witnessed an increased antimicrobial resistance which poses a mammoth challenge for public health management. This has resulted in an increase in morbidity and mortality, resulting in an increase in financial burden to the patients. A recent analysis from 10 hospitals in India reported that mortality rate increases by 1.57 times in patients suffering from multidrug resistance (MDR) bacterial infections as compared to patients infected with similar but susceptible infections. Due to the emergence of MDR and extensively drug-resistant (XDR) bacteria, most of the broad-spectrum antibiotics have been rendered ineffective. The mortality rate with Gram-negative strains is higher than with Gram-positive strains. Tigecycline is the first in class glycylcycline antibiotic with an expanded broad-spectrum activity. Tigecycline enters bacterial cells through energy-dependent pathways or via passive diffusion, to reversibly bind to the 30S ribosomal subunit. It has potent in vitro activity against Gram-negative carbapenemase producers, except Pseudomonas aeruginosa and Proteus spp. It also has good in vitro activity against Carbapenem-resistant Klebsiella pneumoniae strains. Hence, it is considered as a therapeutic option in XDR isolates. Recent meta-analyses have shown tigecycline to be as effective as its comparators with reducing mortality rates. Due to increased resistance reported in carbapenem-resistant isolates in Indian health-care settings, a colistin/polymyxin B-based combination therapy as a treatment option is being sought. A lower mortality rate has been reported with colistin-based combination therapy in Carbapenem-resistant Enterobacteriaceae-associated infections. Combinations with tigecycline, Fosfomycin, and chloramphenicol have shown to improve treatment outcomes. Tigecycline can be a good alternative in MDR and XDR complicated intra-abdominal and complicated skin and soft tissue infections. Appropriately designed clinical trials in Indian health-care setups will reinforce clinician’s confidence in using tigecycline in complex clinical situations.

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In-vitro activity of tigecycline and comparator agents against common pathogens: Indian experience

Cited by 10 publications

References 11 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

Molecular characteristics of antibiotic-resistant Escherichia coli and Klebsiella pneumoniae strains isolated from hospitalized patients in Tehran, Iran

Tigecycline: Role in the Management of cIAI and cSSTI in the Indian Context

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