Lei Zha1,2,3, Dayan Zhang4, Lingling Pan5, Zhichu Ren4, Xiang Li4, Yi Zou4, Shirong Li6, Shuangqi Luo7, Gang Yang6, Boris Tefsen8,9. 1. Emergency and Critical Care Unit, Conch Hospital of Anhui Medical University, Wuhu, 241000, Anhui, China. Lei.zha@liverpool.ac.uk. 2. Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, No. 111, Ren'ai Road, Dushu Lake Higher Education Town, Suzhou Industrial Park, Suzhou, 215123, Jiangsu, China. Lei.zha@liverpool.ac.uk. 3. Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK. Lei.zha@liverpool.ac.uk. 4. Postgraduate School, Wannan Medical College, Wuhu, 241000, Anhui, China. 5. Cardiology Department, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui, China. 6. Pulmonary and Critical Care Department, The Second People's Hospital of Wuhu, Wuhu, 241000, Anhui, China. 7. Intensive Care Unit, The First People's Hospital of Wuhu, Wuhu, 241000, Anhui, China. 8. Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, No. 111, Ren'ai Road, Dushu Lake Higher Education Town, Suzhou Industrial Park, Suzhou, 215123, Jiangsu, China. boris.tefsen@ronininstitute.org. 9. Ronin Institute, Montclair, NJ, 07043, USA. boris.tefsen@ronininstitute.org.
Abstract
INTRODUCTION: Tigecycline is a potential alternative to trimethoprim-sulfamethoxazole in treating Stenotrophomonas maltophilia infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of S. maltophilia infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to S. maltophilia in comparison with fluoroquinolones. METHODS: This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by S. maltophilia receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed. RESULTS: Of 82 patients with S. maltophilia VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%, p = 0.009) and microbiological cure (28.6% vs. 59.1%, p = 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%, p = 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model. CONCLUSIONS: The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with S. maltophilia VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating S. maltophilia VAP unless new clinical evidence emerges.
INTRODUCTION:Tigecycline is a potential alternative to trimethoprim-sulfamethoxazole in treating Stenotrophomonas maltophilia infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of S. maltophilia infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to S. maltophilia in comparison with fluoroquinolones. METHODS: This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by S. maltophilia receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed. RESULTS: Of 82 patients with S. maltophilia VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%, p = 0.009) and microbiological cure (28.6% vs. 59.1%, p = 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%, p = 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model. CONCLUSIONS: The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with S. maltophilia VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating S. maltophilia VAP unless new clinical evidence emerges.
Authors: Hannah H Matson; Bruce M Jones; Jamie L Wagner; Madalyn A Motes; Christopher M Bland Journal: Am J Health Syst Pharm Date: 2019-12-02 Impact factor: 2.637
Authors: Paulina Paprocka; Angelika Mańkowska; Karol Skłodowski; Grzegorz Król; Tomasz Wollny; Agata Lesiak; Katarzyna Głuszek; Paul B Savage; Bonita Durnaś; Robert Bucki Journal: Pathogens Date: 2022-05-26