A review of clinical and microbiological outcomes following treatment of infections involving multidrug-resistant Acinetobacter baumannii with tigecycline
A review of clinical and microbiological outcomes following treatment of infections involving multidrug-resistant Acinetobacter baumannii with tigecycline
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DOI：
10.1093/jac/dkn555
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发表时间：
2009-04-01
影响因子：
5.2
通讯作者：
Wareham, D. W.
中科院分区：
文献类型：
--
作者：
Gordon, N. C.;Wareham, D. W.
多重耐药鲍曼不动杆菌(MRAB)在英国医院是一个日益严重的问题，许多菌株现在对除多粘菌素以外的所有可用的抗生素都有耐药性。替格环素已被用于治疗MRAb，因为它在体外具有活性，但关于其临床疗效的数据有限，尤其是涉及下呼吸道或菌血症的革兰氏阴性感染。对所有服用替格环素治疗MRAb的患者进行了18个月的临床和微生物学结果的回顾性研究。34名患者接受了替格环素治疗MRAb或涉及MRAb的多菌感染。23例(68%)临床结果为阳性：其中10例显示微生物清除。总死亡率为41%(n=14)，其中9例死亡直接归因于败血症。三名患者在接受替加环素治疗时出现革兰氏阴性菌血症，其中一名患者出现了已知的耐药性。总体而言，微生物学和临床结果之间的相关性很差。尽管替格环素在体外仍具有良好的抗MRAb活性，但其临床疗效仍不确定。应该进行一项前瞻性研究，包括联合使用替吉环素和其他抗菌剂，以确定其在治疗MRAB中的作用。
Multidrug-resistant Acinetobacter baumannii (MRAB) is an increasing problem in UK hospitals, with many strains now resistant to all available antibiotics except polymyxins. Tigecycline has been used for the treatment of MRAB as it demonstrates activity in vitro, but there are limited data on its clinical efficacy in Gram-negative infections, especially those involving the lower respiratory tract or bacteraemia.A retrospective study of the clinical and microbiological outcomes of all patients treated with tigecycline for MRAB over an 18 month period was undertaken.Thirty-four patients received tigecycline for MRAB or polymicrobial infection involving MRAB. Twenty-three (68%) had a positive clinical outcome: microbiological clearance was demonstrated in 10 of these. The overall mortality was 41% (n = 14), with nine deaths directly attributable to sepsis. Three patients had episodes of Gram-negative bacteraemia while receiving treatment with tigecycline, with documented resistance occurring in one patient. Overall, the correlation between microbiological and clinical outcomes was poor.While tigecycline retains excellent in vitro activity against MRAB, its clinical efficacy remains uncertain. A prospective study, including the use of tigecycline in combination with other antimicrobial agents, should be undertaken to define its role in the treatment of MRAB.