Karageorgopoulos Drosos E, Kelesidis Theodore, Kelesidis Iosif, Falagas Matthew E
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
J Antimicrob Chemother. 2008 Jul;62(1):45-55. doi: 10.1093/jac/dkn165. Epub 2008 Apr 24.
New antibacterial agents are required for the treatment of infections caused by multidrug-resistant (MDR) Acinetobacter spp. Whether tigecycline constitutes an effective treatment option or not, is not well established. We sought to evaluate the available evidence regarding the microbiological activity and clinical effectiveness of tigecycline for MDR (including the subset of carbapenem-resistant) Acinetobacter spp.
We searched PubMed for relevant articles and extracted/evaluated the available evidence.
We identified 22 microbiological studies reporting data for 2384 Acinetobacter spp. (1906 Acinetobacter baumannii). Susceptibility of at least 90% of the Acinetobacter isolates to tigecycline (with an MIC breakpoint of susceptibility < or =2 mg/L) was noted in 9/18 studies reporting data on MDR Acinetobacter and in 7/15 studies reporting specific data on carbapenem-resistant Acinetobacter. In an additional study reporting data for both resistance categories, adequate susceptibility of Acinetobacter spp. was observed by one (broth microdilution) of the methods employed. The effectiveness of tigecycline for MDR Acinetobacter infections was evaluated in eight identified clinical studies, reporting retrospective data regarding 42 severely ill patients, among whom 31 had respiratory tract infection (in 4 cases with secondary bacteraemia) and 4 had bacteraemia. Tigecycline therapy (in combination with other antibiotics in 28 patients) was effective in 32/42 cases. In three cases, resistance to tigecycline developed during treatment.
Tigecycline showed considerable, though not consistent, antimicrobial activity against MDR (including carbapenem-resistant) Acinetobacter spp. However, data to support its clinical use, particularly for ventilator-associated pneumonia or bacteraemia, caused by these pathogens, are still limited.
治疗多重耐药（MDR）不动杆菌属引起的感染需要新型抗菌药物。替加环素是否构成一种有效的治疗选择尚未明确。我们试图评估关于替加环素对MDR（包括耐碳青霉烯类亚组）不动杆菌属的微生物活性和临床有效性的现有证据。
我们在PubMed上搜索相关文章并提取/评估现有证据。
我们确定了22项微生物学研究，报告了2384株不动杆菌属（1906株鲍曼不动杆菌）的数据。在18项报告MDR不动杆菌数据的研究中的9项以及15项报告耐碳青霉烯类不动杆菌具体数据的研究中的7项中，至少90%的不动杆菌分离株对替加环素敏感（MIC敏感断点<或=2mg/L）。在另一项报告两种耐药类别数据的研究中，所采用的一种方法（肉汤微量稀释法）观察到不动杆菌属有足够的敏感性。在八项确定的临床研究中评估了替加环素对MDR不动杆菌感染的有效性，这些研究报告了42例重症患者的回顾性数据，其中31例有呼吸道感染（4例伴有继发性菌血症），4例有菌血症。替加环素治疗（28例患者联合使用其他抗生素）在42例中的32例有效。在三例患者中，治疗期间出现了对替加环素的耐药。
替加环素对MDR（包括耐碳青霉烯类）不动杆菌属显示出相当大但不一致的抗菌活性。然而，支持其临床应用的数据，特别是对于由这些病原体引起的呼吸机相关性肺炎或菌血症的数据仍然有限。
