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Tigecycline combination for ventilator-associated pneumonia caused by extensive drug-resistant Acinetobacter
Hangyong He1, Yali Zheng2, Bing Sun1
1Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
Background:
Extensive drug-resistant Acinetobacter baumannii (XDR A. baumannii) has emerged as an important pathogen in patients with ventilator-associated pneumonia (VAP) worldwide. This study determined whether or not combination tigecycline (TGC) treatment improved the short-term outcome of patients with XDR A. baumannii-induced VAP. Methods: Fifty-eight patients admitted to our intensive care unit (ICU) with confirmed XDR A. baumannii VAP between January 2011 and June 2013 were retrospectively studied. Fourteen patients were excluded. The included subjects were classified into two groups depending on treatment regimens with or without TGC (TGC group, n=20; non-TGC group, n=24). Thirty-day mortality rates, and clinical and microbiologic responses were reviewed and compared in detail.
Results:
Microbiological eradication was observed in 3 patients (15.0%) in the TGC group and 7 patients (29.2%) in the non-TGC group (P=0.264). The mean time-to-eradication of XDR A. baumannii was 5.3±2.1 versus 7.6±4.0 days (P=0.395). Ten of 20 (50%) patients developed resistance to TGC after initiation of TGC therapy in the TGC group. Clinical cure were achieved in 50.0% of the patients (10/20) in the TGC group and 45.8% of the patients (7/24) in the non-TGC group (P=1.000). No differences existed in the 30-day mortality, length of ICU stay, length of hospital stay (LOS), and length of invasive mechanical ventilation (MV) between the two groups. The occurrence of septic shock was significantly lower in the TGC group (20.0% vs. 54.2%; P=0.030).
Conclusions:
TGC combination therapy did not improve the clinical cure and microbiologic eradication in patients with XDR A. baumannii VAP. TGC combination therapy did not decrease all-cause mortality in patients with XDR A. baumannii VAP. TGC combination therapy reduced the incidence of septic shock in patients with XDR A. baumannii VAP, and might decrease the incidence of poly-microbial VAP. TGC combination therapy can only be recommended as an option when other optimized therapeutics, such as colistin, are unavailable.
Insights
Combination tigecycline therapy did not improve outcomes for ventilator-associated pneumonia caused by extensively drug-resistant Acinetobacter baumannii. However, it did reduce the incidence of septic shock in these patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Extensively drug-resistant Acinetobacter baumannii (XDR A. baumannii) is a significant cause of ventilator-associated pneumonia (VAP).
- Assessing novel treatment strategies is crucial for managing XDR A. baumannii VAP.
Purpose of the Study:
- To evaluate the efficacy of combination tigecycline (TGC) therapy in improving short-term outcomes for patients with XDR A. baumannii VAP.
- To compare clinical cure, microbiological eradication, and mortality rates between TGC and non-TGC treatment groups.
Main Methods:
- Retrospective study of 44 patients with confirmed XDR A. baumannii VAP.
- Patients were divided into two groups: those receiving combination TGC therapy (n=20) and those not (n=24).
- Outcomes including 30-day mortality, clinical response, and microbiological eradication were analyzed.
Main Results:
- No significant difference in clinical cure rates (50.0% vs 45.8%) or microbiological eradication (15.0% vs 29.2%) between the TGC and non-TGC groups.
- Development of TGC resistance was observed in 50% of patients in the TGC group.
- Significantly lower incidence of septic shock in the TGC group (20.0% vs 54.2%, P=0.030).
Conclusions:
- Combination tigecycline therapy did not improve clinical cure or microbiological eradication for XDR A. baumannii VAP.
- TGC therapy did not reduce all-cause 30-day mortality.
- TGC combination therapy may reduce the incidence of septic shock and poly-microbial VAP, suggesting its use when other options are limited.
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