Tigecycline for the treatment of patients with severe sepsis or septic shock:: a drug use evaluation in a surgical intensive care unit
Tigecycline for the treatment of patients with severe sepsis or septic shock:: a drug use evaluation in a surgical intensive care unit
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DOI：
10.1093/jac/dkm541
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发表时间：
2008-03-01
影响因子：
5.2
通讯作者：
Weigand, Markus A.
中科院分区：
文献类型：
--
作者：
Swoboda, Stefanie;Ober, Michael;Weigand, Markus A.
目的：充分的抗菌药物治疗对严重医院感染的危重患者的生存至关重要。替加环素是新一类甘环素中第一种可用的药物，对多重耐药革兰氏阳性和革兰氏阴性细菌具有活性。本观察性回顾性评价的目的是评估三级医疗中心外科重症监护病房（SICU）的替加环素使用模式。方法：对我院70例接受替加环素治疗的患者资料进行分析。我们从人口统计数据和合并症、疾病严重程度、临床适应症、微生物学、治疗方案和死亡率方面回顾了替加环素的使用。进行逻辑回归分析以确定死亡率的预后因素。结果：大多数患者有合并症，如癌症（51%）或肾脏替代治疗（57%）。患者入院时急性生理和慢性健康评估（APACHE） II平均评分为27分。最常见的诊断是腹腔感染（50%的患者）；诊断为腹腔感染和肺炎的占14%。在16%的患者中发现耐甲氧西林金黄色葡萄球菌（定植；感染：6%），27%的患者中发现万古霉素耐药肠球菌（定植；感染：21%）。替加环素治疗的平均持续时间为9±4天；76%的患者接受替加环素联合治疗，64%的患者接受二线治疗。APACHE评分和肾脏替代被确定为死亡率的预测因素。SICU死亡率为30%。结论：替加环素治疗SICU重症脓毒症或感染性休克的病死率明显较低。替加环素可能是对其他可用药物耐药的脓毒症患者的重要治疗选择。
Objectives: Adequate antimicrobial therapy is crucial for the survival of critically ill patients with severe nosocomial infections. Tigecycline, the first available agent in the new class of glycylcyclines, is active against multiresistant Gram-positive and Gram-negative bacteria. The aim of this observational, retrospective evaluation was to assess tigecycline use patterns in a surgical intensive care unit (SICU) of a tertiary care centre.Methods: Data from 70 patients receiving tigecycline in the SICU were analysed. We reviewed tigecycline use in terms of demographic data and co-morbidities, disease severity, clinical indication, microbiology, therapy regimens and mortality. A logistic regression analysis was performed to identify prognostic factors for mortality.Results: The majority of patients had co-morbidities such as cancer (51%) or renal replacement therapy (57%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score of patients at admission was 27. Intra-abdominal infection was most frequently diagnosed (50% of patients); intra-abdominal infection and pneumonia were diagnosed in 14%. Methicillin-resistant Staphylococcus aureus was found in 16% of patients (colonization; infection: 6%) and vancomycin-resistant enterococci in 27% (colonization; infection: 21%). The mean duration of tigecycline therapy was 9 +/- 4 days; 76% of patients received tigecycline in combination, with 64% being treated second line. APACHE score and renal replacement were identified as predictive factors for mortality. SICU mortality was 30%.Conclusions: Tigecycline treatment of critically ill SICU patients with severe sepsis or septic shock appeared to result in remarkably low mortality. Tigecycline may be an important treatment option for septic patients with infections resistant to other available agents.