Main Article Content
Introduction: Tigecycline is an antimicrobial agent, approved for the treatment of complicated skin and soft tissue infections, hospital-acquired and community-acquired pneumonia, intra-abdominal infections and anaerobic or atypical infections. Objective: To describe the use of tigecycline in a teaching hospital and to compare data from patients who had their prescriptions audited by the hospital infection committee with those who did not have audited prescriptions. Methods: Retrospective observational cohort study conducted at a teaching hospital from April 2012 to March 2014 including patients who received tigecycline. Demographic variables, comorbidities, microbiological findings, prescribed antibiotics and technical opinions issued by the Hospital Infection Control Service were collected. Results: 71 patients were included, aged between 13 and 92 years, 63.4% were male and 56.3% were non-white. Tigecycline was the first antimicrobial choice in 19.7% (14/71) of the cases, while the use associated with other antibiotics was observed in 66.2% (45/71) of the prescriptions. mainly with meropenem (28.9%). Empirical use was performed in 69.0% of cases, after culture and the antibiogram in 31.0% and off label use in 81.7%. The microorganisms frequently identified by the culture tests were Enterococcus faecalis (17.6%), Pseudomonas aeruginosa (14.7%) and Klebsiella penumoniae (11.8%). Conclusion: The study demonstrated that empirical and off label use is common in clinical practice and few prescriptions were guided by the results of the culture and the antibiogram, demonstrating the need for prescribers to evaluate the benefits/ risks of using this antibiotic, risk of resistance, adverse effects and drug interactions, in addition to cost.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY) that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
2. Frampton JE, Curran MP. Tigecycline. Drugs. 2005;65(18):2623-35. https://doi.org/10.2165/00003495-200565180-00008
3. Rosa FG, Corcione S, Di Perri G, Scaglione F. Re-trailing Tigecycline Therapy. New Microbiol. 2015;38(2):121-36.
4. Baadani AM, Thawadi SI, El-Khizzi NA, Omrani AS. Prevalence of colistin and tigecycline resistance in Acinetobacter baumannii clinical isolates from 2 hospitals in Riyadh Region over a 2-year period. Saudi Med J. 2013;34(3):248-53.
5. Dhabaan GN, AbuBakar S, Shorman MA, Hassan H. In vitro activity of tigecycline against Acinetobacter baumannii isolates from a teaching hospital in Malaysia. J Chemother. 2012;24(2):87-92. https://doi.org/10.1179/1120009X12Z.00000000017
6. Barberàn J, Salso S, Alhambra A. Tigecycline: 10 years of history and still in full force. Rev Esp Quimioter. 2015;28(2):61-78.
7. Ulu-Kilic A, Alp E, Altun D, Cevahir F, Kalin G, Demiraslan H. Increasing frequency of Pseudomonas aeruginosa infections during tigecycline use. J Infect Dev Ctries. 2015;9(3):309-12. https://doi.org/10.3855/jidc.4700
8. Yahav D, Lador A, Paul M, Leibovici L. Efficacy and safety of tigecycline: a systematic review and meta-analysis. J Antimicrob Chemother. 2011;66(9):1963-71. https://doi.org/10.1093/jac/dkr242
9. Gazarian M, Kelly M, McPhee JR, Graudins LV, Ward RL, Campbell TJ. Off-label use of medicines: consensus recommendations for evaluating appropriateness. Med J Aust. 2006;185(10):544-8.
10. Curcio D, Vargas SW, Ubiergo SG, Varón F, Suarez JR, Chavez CP, et al. Tigecycline treatment of critically ill patients: the LatinUser experience. Curr Clin Pharmacol. 2011;6(1):18-25. https://doi.org/10.2174/157488411794941304
11. Curcio D, Fernández F, Cané A, Barcelona L, Stamboulian D; The Tigecycline Initial Use Registry Group. Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry. Braz J Infect Dis. 2008;12(3):198-201. https://doi.org/10.1590/S1413-86702008000300007
12. Curcio D, Fernandez F, Duret F. [Initial use of tigecycline in Argentina]. Rev Chilena Infectol. 2007;24(6):497-9. http://dx.doi.org/10.4067/S0716-10182007000600012
13. Basseti M, Eckmann C, Boadmann KF, Dupont H, Heizmann WR, Montravers P, et al. Prescription behaviours for tigecycline in real-life clinical practice from five European observational studies. J Antimicrob Chemother. 2013;68(Suppl 2):ii5-14. https://doi.org/10.1093/jac/dkt140
14. Eckmann C, Montravers P, Basseti M, Bodmann KF, Heizmann WR, García MS, et al. Efficacy of tigecycline for the treatment of complicated intra-abdominal infections in real-life clinical practice from five European observational studies. J Antimicrob Chemother. 2013;68(Suppl 2):ii25-35. https://doi.org/10.1093/jac/dkt142
15. Monstravers P, Basseti M, Dupont H, Eckmann C, Heizmann WR, Guirao X, et al. Efficacy of tigecycline for the treatment of complicated skin and soft-tissue infections in real-life clinical practice from five European observational studies. J Antimicrob Chemothe. 2013;68(Suppl 2):ii15-24. https://doi.org/10.1093/jac/dkt141
16. Rossi F. The challenges of antimicrobial resistance in Brazil. Clin Infect Dis. 2011;52(9):1138-43. https://doi.org/10.1093/cid/cir120
17. Alvarez-Lerma F, Blanco L, Rodríguez JA, Grau S, Conde-Estévez D, Luque S. Differences in the use of tigecycline between ICU patients and non-ICU patients. Rev Esp Quimioter. 2010;23(2):63-71.
18. Curcio D, Alí A, Duarte A, Pauta AD, Ibáñez-Guzmán C, Sang MC et al. Prescription of antibiotics in intensive care units in Latin America: an observational study. J Chemother. 2009;21(5):527-34. https://doi.org/10.1179/joc.2009.21.5.527
19. González-del Castillo J, Domínguez-Bernal C, Gutiérrez-Martín MC, Núñez-Orantos MJ, Candel FJ, Martín-Sánchez FJ. Efecto de la inadecuación de la antibioterapia en Urgencias sobre la eficiencia en la hospitalización. Enferm Infec Microb Clín. 2017;35(4):208-213. https://doi.org/10.1016/j.eimc.2015.10.005
20. Montravers P, Dupont H, Bedos JP, Bret P; Tigecycline Group. Tigecycline use in critically ill patients: a multicentre prospective observational study in the intensive care setting. Intensive Care Med. 2014;40(7):988-97. https://doi.org/10.1007/s00134-014-3323-7
21. Heizmann WR, Löschmann PA, Eckmann C, von Eiff C, Bodmann KF, Petrik C. Clinical efficacy of tigecycline used as monotherapy or in combination regimens for complicated infections with documented involvement of multiresistant bacteria. Infection. 2015;43:37-43. https://doi.org/10.1007/s15010-014-0691-4
22. Bassetti M, Nicolini L, Repetto E, Righi E, Del Bono V, Viscoli C. Tigecycline use in serious nosocomial infections: a drug use evaluation. BMC Infect Dis. 2010;10:287. https://doi.org/10.1186/1471-2334-10-287
23. U. S. Food and Drug Administration. FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections [internet] 2013. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-increased-risk-death-tygacil-tigecycline-compared-other-antibiotics.
24. Wang J, Pan Y, Shen J, Xu Y. The efficacy and safety of tigecycline for the treatment of bloodstream infections: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob. 2017;16:24. https://doi.org/10.1186/s12941-017-0199-8