Tigecycline usage in cancer patients with refractory pneumonia: a report on 38 cases. A single-institution study
Abstract number: 1733_227
Chemaly R., Hachem R., Hanmod S., Adachi J., Hogan H., Mulanovich V., Kontoyiannis D., Safdar A., Raad I., Rolston K.
Background: Tigecycline (TG), first in a new class of Glycylclines, is a novel agent approved for treatment of complicated soft tissue and intraabdominal infections in adults. Clinical data on the safety and efficacy of TG in cancer pts with pneumonia is lacking.
Methods: We reviewed records of cancer pts with pneumonia treated with TG for >72 h between Sept'05 and Sept'06. Data collection included demographics, cancer type, indication for TG, side effects and outcome.
Results: Thirty-eight pts with pneumonia were identified, 4 (10%) of them had ventilator-associated pneumonia. Median age was 56 years (2379 y). Most pts (28, 74%) had haematologic malignancies, including 14 allogeneic HSCT pts; 13 pts (34%) were neutropenic (ANC < 500/mm3). Twenty-six pts (68%) were in the ICU of whom 18 (69%) required ventilator support after development of pneumonia. Thirty-six (95%) pts received TG as second line agent (after failure of other broad-spectrum antibiotics) and in combination with an anti-pseudomonal drug(s) and the remaining 2 pts received it as a first line agent because of allergy to vancomycin and/or b-lactams. Median duration of therapy was 11 d (435 d). Twenty-eight pts (74%) received TG for refractory pneumonia of unknown etiology and 10 pts (26%) for microbiologically documented pneumonia with multi-drug resistant organisms (MDRO) [MRSA, S. maltophilia, E. coli, VRE, and Acinetobacter]. Clinical response was noted in 24 pts (63%); including 4 of the 5 pts who had associated bacteraemia and 2 pts with associated intra-abdominal infections. Eight of the 10 (80%) patients who had microbiologically documented pneumonia responded to the treatment. The remainder 14 pts died (37%). The cause of death was multi-organ failure and pneumonia of unknown etiology in 10 pts; MDR P. Aeuroginosa bacteraemia, aspergillosis, S. maltophilia and VRE pneumonia in 1 each. Of the 9 pts who were not on anti-emetics and were not intubated, only 1 developed mild nausea. Diarrhoea was noted in 1 pt.
Conclusions: Combination of TG with anti-pseudomonal drug(s) appears to be an appropriate choice for treatment of refractory pneumonia secondary or not to MDRO (excluding P. aeuroginosa) in cancer patients, including HSCT recipients.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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