Treatment with Tigecycline of Recurrent Urosepsis Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coli

Abstract

A 25-year-old female was admitted to our intensive care unit with septic shock and multiorgan failure caused by extended-spectrum ␤-lactamase-producing Escherichia coli originating from the right renal pelvis. A 16-day course of treatment with meropenem reversed the septic condition, but the infection recurred thereafter. The patient recovered fully after therapy was changed to tigecycline. CASE REPORTA 25-year-old female presented at a private practice with lower abdominal pain. A urinary tract infection was suspected, and she was started on levofloxacin. Three days later, she presented with increasing abdominal pain at a municipal hospital, where she was diagnosed as suffering from urosepsis. She was immediately admitted to the intensive care unit (ICU), and the antibiotic treatment was switched to intravenous piperacillin-tazobactam.Her past medical history was remarkable, since she was born with lumbar meningomyelocele and paraparesis below the second lumbar segment. She also suffered from neurogenic impairment of bladder emptying, leading to chronic reflux into the renal pelvis. She had suffered from repeated episodes of pyelonephritis, which had caused cirrhosis of the kidneys and chronic renal impairment. She had not been on dialysis except for a short period, nine years earlier. Furthermore, she had undergone the following surgical procedures in the past: implantation of a ventriculo-atrial shunt for treatment of hydrocephalus, bladder augmentation plasty, osteotomy at the left hip, and correction of pes equinus by Achilles' tendon plasty.Despite treatment with piperacillin-tazobactam, the condition of the patient deteriorated rapidly and dramatically, and she was intubated 1 day after ICU admission due to respiratory failure and development of septic shock. She required mechanical ventilation with 70% oxygen, and noradrenaline was applied up to 0.2 g/kg of body weight/min. Antibiotic therapy was changed to cefotaxime and amikacin. Her platelet count fell to 20,000/l, which was interpreted as septic thrombocytopenia, and she developed anuric renal failure. A urinary sample obtained 1 day after ICU admission grew Escherichia coli, but antibiotic suscebtibility testing was still pending. In this situation, the patient was transferred by helicopter to the University Hospital of Tübingen, which is a tertiary-care hospital, for further treatment of the life-threatening condition.A computed tomography (CT) scan performed upon admission showed severe alterations of the lung tissue, which confirmed the diagnosis of acute respiratory distress syndrome. Additionally, pneumonic infiltrates were suspected on both sides in the dorsobasal regions. The kidney tissues showed chronic alterations, and the picture was compatible with pyelonephritis and several smaller renal abscesses (Fig. 1).After the CT scan, the patient was transferred immediately to our ICU, where blood cultures and a tracheal aspirate were obtained, followed by the immediate start of antimicrobial therapy with meropenem, linezolid, and voriconazole. N...

Systematic Review and Meta-Analysis of the Effectiveness and Safety of Tigecycline for Treatment of Infectious Disease

“…Many other case series and case reports have revealed the success of treatment with tigecycline against MDR isolates, such as MRSA (27,29), Acinetobacter spp. (10,37,41,47), Klebsiella pneumoniae (8,11,14), Klebsiella pneumoniae causing meningitis (48), VRE (25,36), E. coli (28,40), and Clostridium difficile (21), although in some of these studies tigecycline was combined with other antibiotics, such as colistin (8,37,38), daptomycin (25), and ciprofloxacin (48). However, recent several articles (1, 33) reported on the emergence of tigecycline-resistant strains after tigecycline therapy.…”

Clinical Significance of the Pharmacokinetic and Pharmacodynamic Characteristics of Tigecycline

“…Specifically, the overall cure rate achieved with tigecycline treatment in the above category of patients was 84.5%, regarding 85 patients, in total. Furthermore, the cases of 25 patients who have received tigecycline treatment with or without other concomitant antibacterial agents for the treatment of secondary or primary bacteremia caused by various pathogens, such as MDR A. baumannii, Enterobacteriaceae, and MRSA, have been reported in 9 studies [58,60,62,63,[66][67][68][69][70]. The majority of these patients were in a critical clinical condition or had serious comorbidity.…”

Comparative Effectiveness of Aminoglycosides, Polymyxin B, and Tigecycline for Clearance of Carbapenem-Resistant Klebsiella pneumoniae from Urine

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