High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii in Intensive Care Unit

doi:10.2147/IDR.S249352

. 2020 May 18:13:1447-1454.

doi: 10.2147/IDR.S249352. eCollection 2020.

High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii in Intensive Care Unit

Xiang-Rong Bai^{1

2}, De-Chun Jiang^{1

2}, Su-Ying Yan^{1

2}

Affiliations

¹ Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China.
² National Clinical Research Center for Geriatric Disorder, Beijing, People's Republic of China.

PMID: 32547113
PMCID: PMC7244348
DOI: 10.2147/IDR.S249352

High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii in Intensive Care Unit

Xiang-Rong Bai et al. Infect Drug Resist. 2020.

. 2020 May 18:13:1447-1454.

doi: 10.2147/IDR.S249352. eCollection 2020.

Authors

Xiang-Rong Bai^{1

2}, De-Chun Jiang^{1

2}, Su-Ying Yan^{1

2}

Affiliations

¹ Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China.
² National Clinical Research Center for Geriatric Disorder, Beijing, People's Republic of China.

PMID: 32547113
PMCID: PMC7244348
DOI: 10.2147/IDR.S249352

Abstract

Purpose: The association between clinical and microbiological outcomes and high-dose tigecycline (TGC) was assessed in elderly (≥60 years old) patients with hospital-acquired and ventilator-associated pneumonia due to multidrug-resistant Acinetobacter baumannii(A. baumannii). This study also assessed tigecycline combination with different antibiotics and its influence on the outcome.

Patients and methods: An observational retrospective cohort study was conducted. Patients over 60 years old were treated with standard-dose (SD) TGC (100-mg intravenous TGC initially, followed by 50-mg doses administered intravenously twice daily) and high-dose (HD) TGC (200-mg intravenous TGC initially, followed by 100-mg doses administered intravenously twice daily) for a microbially confirmed infection. The outcome was 30-day crude mortality, co-administered antimicrobial agent and the microbial eradication percentage in both groups.

Results: A total of 48 multidrug-resistant A. baumannii respiratory patients were identified. Tigecycline was administered to 85% of ventilation-associated pneumonia (VAP) patients (28/33) in the SD group and 80% of VAP patients (12/15) in the HD group. Combined therapy was the major treatment option in both groups, accounting for 85% and 87%, respectively. Median treatment duration in both groups was 7.36 vs 8.6 days, respectively. Survival days were 13.61 vs 12.4 days (P=0.357), respectively. The 30-day crude mortality was 39.4% (13/33) for the SD group and 14% (2/15) for the HD group (P=0.098). The microbial eradication rate of respiratory specimens in the SD group was higher than that in the HD group (P=0.02). The variables associated with 30-day crude mortality were chronic obstructive pulmonary disease (hazard ratio [HR] 11.63, 95% CI 1.094-123.058; P=0.042), tigecycline treatment duration (HR 0.690, 95% CI 0.515-0.926; P=0.013), and surgery before infection (HR 79.276, 95% CI 6.983-899.979; P=0.000). High-dose tigecycline was not associated with 30-day crude mortality (adjusted HR 0.329, 95% CI 0.074-1.460; P=0.145). Combined antibiotics was also not different between the two groups.

Conclusions: High-dose tigecycline was not associated with 30-day crude mortality in elderly patients with pneumonia due to multidrug-resistant A. baumannii, although the microbial eradication rate was high.

Keywords: Acinetobacter baumannii; critical ill patients; drug-resistant; high-dose tigecycline; pneumonia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

**Figure 1**
Kaplan–Meier curves for mortality as a function of SD TGC or HD TGC by survival days.

See this image and copyright information in PMC

Cited by

Rational use of tigecycline and tigecycline blood concentration monitoring in patients with severe infection.
Yu M, Wu S, Qi B, Wu X, Deng X. Yu M, et al. Biomed Rep. 2023 Jun 13;19(2):51. doi: 10.3892/br.2023.1634. eCollection 2023 Aug. Biomed Rep. 2023. PMID: 37426765 Free PMC article.
Clinical Efficacy, Antibiotic Resistance Genes, Virulence Factors and Outcome of Hospital-Acquired Pneumonia Induced by Klebsiella pneumoniae Carbapenemase 2-Producing with Tigecycline Treatment in the ICU.
Bai XR, Cao JR, Wang ZZ, Li WC, Chen DD, Lou R, Qu X, Yan SY. Bai XR, et al. Infect Drug Resist. 2022 Sep 21;15:5545-5555. doi: 10.2147/IDR.S381280. eCollection 2022. Infect Drug Resist. 2022. PMID: 36168639 Free PMC article.
High-Dose versus Standard-Dose Tigecycline Treatment of Secondary Bloodstream Infections Caused by Extensively Drug-Resistant Acinetobacter baumannii: An Observational Cohort Study.
Han H, Qin W, Zheng Y, Cao D, Lu H, Zhang L, Cui Y, Hu Y, Li W, Guo H, Wu D, Li C, Wang H, Chen Y. Han H, et al. Infect Drug Resist. 2021 Sep 18;14:3837-3848. doi: 10.2147/IDR.S322803. eCollection 2021. Infect Drug Resist. 2021. PMID: 34566417 Free PMC article.

References

1. Kalanuria AA, Ziai W, Zai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18(2):208. doi:10.1186/cc13775 - DOI - PMC - PubMed
1. Zilberberg MD, Nathanson BH, Sulham K, Fan W, Shorr AF. Multidrug resistance, inappropriate empiric therapy, and hospital mortality in Acinetobacter baumannii pneumonia and sepsis. Crit Care. 2016;20(1):221. doi:10.1186/s13054-016-1392-4 - DOI - PMC - PubMed
1. Goel V, Hogade SA, Karadesai S. Ventilator associated pneumonia in a medical intensive care unit: microbial aetiology, susceptibility patterns of isolated microorganisms and outcome. Indian J Anaesth. 2012;56(6):558–562. doi:10.4103/0019-5049.104575 - DOI - PMC - PubMed
1. Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis. 2008;46(8):1254–1263. doi:10.1086/529198 - DOI - PubMed
1. Garnacho-Montero J, Dimopoulos G, Poulakou G, et al. Task force on management and prevention of Acinetobacter baumannii infections in the ICU. Intensive Care Med. 2015;41(12):2057–2075. doi:10.1007/s00134-015-4079-4 - DOI - PubMed

Grants and funding

This research was funded by Beijing Municipal Administration of Hospitals Incubating Program (PX2020038).

LinkOut - more resources

Full Text Sources

[1] Kalanuria AA, Ziai W, Zai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18(2):208. doi:10.1186/cc13775 - DOI - PMC - PubMed

[2] Kalanuria AA, Ziai W, Zai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18(2):208. doi:10.1186/cc13775 - DOI - PMC - PubMed

[3] Zilberberg MD, Nathanson BH, Sulham K, Fan W, Shorr AF. Multidrug resistance, inappropriate empiric therapy, and hospital mortality in Acinetobacter baumannii pneumonia and sepsis. Crit Care. 2016;20(1):221. doi:10.1186/s13054-016-1392-4 - DOI - PMC - PubMed

[4] Zilberberg MD, Nathanson BH, Sulham K, Fan W, Shorr AF. Multidrug resistance, inappropriate empiric therapy, and hospital mortality in Acinetobacter baumannii pneumonia and sepsis. Crit Care. 2016;20(1):221. doi:10.1186/s13054-016-1392-4 - DOI - PMC - PubMed

[5] Goel V, Hogade SA, Karadesai S. Ventilator associated pneumonia in a medical intensive care unit: microbial aetiology, susceptibility patterns of isolated microorganisms and outcome. Indian J Anaesth. 2012;56(6):558–562. doi:10.4103/0019-5049.104575 - DOI - PMC - PubMed

[6] Goel V, Hogade SA, Karadesai S. Ventilator associated pneumonia in a medical intensive care unit: microbial aetiology, susceptibility patterns of isolated microorganisms and outcome. Indian J Anaesth. 2012;56(6):558–562. doi:10.4103/0019-5049.104575 - DOI - PMC - PubMed

[7] Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis. 2008;46(8):1254–1263. doi:10.1086/529198 - DOI - PubMed

[8] Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis. 2008;46(8):1254–1263. doi:10.1086/529198 - DOI - PubMed

[9] Garnacho-Montero J, Dimopoulos G, Poulakou G, et al. Task force on management and prevention of Acinetobacter baumannii infections in the ICU. Intensive Care Med. 2015;41(12):2057–2075. doi:10.1007/s00134-015-4079-4 - DOI - PubMed

[10] Garnacho-Montero J, Dimopoulos G, Poulakou G, et al. Task force on management and prevention of Acinetobacter baumannii infections in the ICU. Intensive Care Med. 2015;41(12):2057–2075. doi:10.1007/s00134-015-4079-4 - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii in Intensive Care Unit

Affiliations

High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii in Intensive Care Unit

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Grants and funding

LinkOut - more resources

Full Text Sources

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Related information

Grants and funding

LinkOut - more resources

Full Text Sources