High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria.
High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria.
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DOI：
10.1186/cc13858
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发表时间：
2014-05-05
期刊：
影响因子：
--
通讯作者：
Antonelli M
中科院分区：
文献类型：
--
作者：
De Pascale G;Montini L;Pennisi M;Bernini V;Maviglia R;Bello G;Spanu T;Tumbarello M;Antonelli M
ICU患者中多药耐药（MDR）细菌的高发生率决定了替加环素（TGC）用于治疗严重感染的增加。已经提出了关于这种分子的功效的许多担忧，并且已经提出了增加剂量。我们的目的是研究TGC在高于标准剂量下的安全性和有效性。我们对罗马一家教学医院ICU前瞻性收集的数据进行了回顾性研究。分析了所有接受TGC治疗的微生物学确诊感染患者的数据。研究了高剂量方案使用的安全性特征和疗效。在研究期间，54例患者（患者）接受标准剂量TGC（SD组：每12小时50 mg），46例患者接受高剂量TGC（HD组：每12小时100 mg）。耐碳青霉烯鲍曼不动杆菌（blaOXA-58和blaOXA-23基因）和肺炎克雷伯菌（blaKPC-3基因）是主要分离的病原体（n = 79）。没有患者因为不良事件而需要停止TGC或降低剂量。在呼吸机相关性肺炎人群（VAP）亚组中（63例患者：30例接受SD，33例接受HD），临床治愈的唯一独立预测因素是使用高剂量替加环素（比值比（OR）6.25; 95%置信区间（CI）1.59至24.57; P = 0.009），而初始抗菌治疗不足（IIAT）（OR 0.18; 95%CI 0.05 - 0.68; P = 0.01）和更高的序贯器官衰竭评估（SOFA）评分（OR 0.66; 95%CI 0.51 - 0.87; P = 0.003）与临床失败独立相关。在一组严重感染的危重患者中，TGC在高于标准剂量时耐受良好。在VAP亚组中，由于革兰氏阴性MDR细菌，高剂量方案与比常规给药更好的结局相关。
The high incidence of multidrug-resistant (MDR) bacteria among patients admitted to ICUs has determined an increase of tigecycline (TGC) use for the treatment of severe infections. Many concerns have been raised about the efficacy of this molecule and increased dosages have been proposed. Our purpose is to investigate TGC safety and efficacy at higher than standard doses. We conducted a retrospective study of prospectively collected data in the ICU of a teaching hospital in Rome. Data from all patients treated with TGC for a microbiologically confirmed infection were analyzed. The safety profile and efficacy of high dosing regimen use were investigated. Over the study period, 54 patients (pts) received TGC at a standard dose (SD group: 50 mg every 12 hours) and 46 at a high dose (HD group: 100 mg every 12 hours). Carbapenem-resistant Acinetobacter.baumannii (blaOXA-58 and blaOXA-23 genes) and Klebsiella pneumoniae (blaKPC-3 gene) were the main isolated pathogens (n = 79). There were no patients requiring TGC discontinuation or dose reduction because of adverse events. In the ventilation-associated pneumonia population (VAP) subgroup (63 patients: 30 received SD and 33 HD), the only independent predictor of clinical cure was the use of high tigecycline dose (odds ratio (OR) 6.25; 95% confidence interval (CI) 1.59 to 24.57; P = 0.009) whilst initial inadequate antimicrobial treatment (IIAT) (OR 0.18; 95% CI 0.05 to 0.68; P = 0.01) and higher Sequential Organ Failure Assessment (SOFA) score (OR 0.66; 95% CI 0.51 to 0.87; P = 0.003) were independently associated with clinical failure. TGC was well tolerated at a higher than standard dose in a cohort of critically ill patients with severe infections. In the VAP subgroup the high-dose regimen was associated with better outcomes than conventional administration due to Gram-negative MDR bacteria.
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影响因子：
14.2
作者：
Magiorakos, A. -P.;Srinivasan, A.;Monnet, D. L.
通讯作者：
Monnet, D. L.
影响因子：
38.9
作者：
Tumbarello, Mario;De Pascale, Gennaro;Antonelli, Massimo
通讯作者：
Antonelli, Massimo
DOI：
10.1016/j.diagmicrobio.2010.10.020
发表时间：
2011-02-01
影响因子：
2.9
作者：
Sader, Helio S.;Farrell, David J.;Jones, Ronald N.
通讯作者：
Jones, Ronald N.
影响因子：
3.7
作者：
Bassetti M;Nicolini L;Repetto E;Righi E;Del Bono V;Viscoli C
通讯作者：
Viscoli C
血管内导管相关感染的诊断和管理临床实践指南：2009年美国传染病学会的更新。
DOI：
10.1086/599376
发表时间：
2009-07-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Mermel LA;Allon M;Bouza E;Craven DE;Flynn P;O'Grady NP;Raad II;Rijnders BJ;Sherertz RJ;Warren DK
通讯作者：
Warren DK