Tigecycline in the treatment of multidrug-resistant Acinetobacter baumannii pneumonia
Abstract number: O510
Tasbakan M.S., Pullukcu H., Sipahi O., Tasbakan M., Aydemir S., Bacakoglu F.
Objectives: Nosocomial infections by multidrug-resistant (MDR) A. baumannii are important causes of mortality in intensive care units (ICU). The treatment choices are limited. The aim of this study was to evaluate the efficacy of tigecyline in MDR A. baumannii pneumonia.
Method: This study was performed at a tertiary-care educational university hospital with an active respiratory diseases ward with 100 beds, 8 of which are in ICU. We retrospectively evaluated the outcome of adult (>18 years old) patients with culture proven MDR A. baumannii pneumoniae treated with tigecycline between January 2009 and November 2009. Demographic, clinical and laboratory data, predisposing factors, as well as information on response to treatment and outcome were obtained from each patient's hospital records.
Results: There were a total of 34 cases (18 male, mean age 66.79±14.84 years) fulfilling our inclusion criteria. On the admission 17 cases were diagnosed as community-acquired pneumonia and 12 were diagnosed as chronic obstructive lung disease. 27 cases (79.4%) had comorbidities and the most common comorbidity was atherosclerotic heart disease (8 cases) followed by diabetes mellitus (5 cases), cerebrovascular disease (5 cases), respectively. When A. baumannii was isolated from respiratory samples 19 were considered as ventilator-associated pneumonia and 15 were considered as hospital-acquired pneumonia. All isolates were sensitive to tigecycline, whereas all were resistant to piperacillin/tazobactam and ceftazidime, 74%, 56%, 41% and 24% were resistant to imipenem, cefoperazone/sulbactam, amikacin and netilmicin, respectively. Tigecycline was used for a mean duration of 9.6±5.2 days. Microbiologic eradication (on day 3 and 7) was observed in 21 cases (61.8%). Tigecycline was combined with cefoperazone/sulbactam in 12 cases, with netilmicin in 6 cases and with amikacin in 3 cases. Nine of 21 cases with microbiologic eradication were lost whereas mortality was 100% in the other 13 cases (p = 0.0006). Mortality and microbiologic eradication rates were not different in combination vs monotherapy (p > 0.05). Mortal cases were elder than the survivors (71.1±12.6 vs 58.9±15.9, p = 0.02). Toxicity developed only in one case as liver toxicity.
Conclusion: Our findings show that microbiologic eradication rate of tigecycline in MDR A. baumannii is not very low. However this microbiologic eradication rate did not result in good clinical results in terms of mortality probably due to comorbidities.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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