Kuo Shu-Chen, Wang Fu-Der, Fung Chang-Phone, Chen Liang-Yu, Chen Su-Jung, Chiang Mei-Chun, Hsu Shih-Fen, Liu Cheng-Yi
Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Microbiol Immunol Infect. 2011 Feb;44(1):45-51. doi: 10.1016/j.jmii.2011.01.009. Epub 2011 Jan 12.
Tigecycline was approved for the treatment of complicated intra-abdominal and complicated skin/skin structure infections. Because of its in vitro effectiveness for multidrug-resistant (MDR) isolates, tigecycline has been prescribed more broadly. This study evaluated tigecycline use after its first introduction in Taiwan and experience with tigecycline for the treatment of MDR Acinetobacter baumannii (MDRAB) infection, especially for ventilator-associated pneumonia.
Patients treated with tigecycline were collected retrospectively from February 2008 to July 2008 in Taipei Veterans General Hospital, a 2,900-bed tertiary care medical center in Taiwan. Patients were divided into three groups according to the indications: Group 1, Food and Drug Administration-approved indications; Group 2, health care-associated pneumonia (HAP); and Group 3, urinary tract infection, osteomyelitis, bacteremia, etc. Cases of MDRAB were also identified.
Among 66 cases, indications for the administration of tigecycline included Food and Drug Administration-approved indications (12, 18.2%), HAP (38, 57.6%), bacteremia (3, 4.5%), catheter-related infections (3, 4.5%), urinary tract infection (4, 6.1%), osteomyelitis (4, 6.1%), and others (2, 3%). Clinical outcome was positive in 20 cases, with higher clinical success rate for Group 1 than Group 2, which may correlate with higher Sequential Organ Failure Assessment score, older age, and more frequent intensive care admission in Group 2. Of the microbiologically evaluable cases, MDRAB predominated (33/51, 64.7%). Among infections with MDRAB (excluding pneumonia without ventilator), the clinical success rate was 12% (3/25).
The most common indication for the prescription of tigecycline was HAP. Success rate for MDRAB infection was lower than that previously reported, possibly because of serious underlying conditions and comorbidities in our patients. Because of limited choices, physicians should weigh the risk and benefit for prescribing tigecycline.
替加环素已被批准用于治疗复杂性腹腔内感染和复杂性皮肤/皮肤结构感染。由于其对多重耐药（MDR）菌株具有体外有效性，替加环素的处方应用更为广泛。本研究评估了替加环素在台湾首次引入后的使用情况以及使用替加环素治疗多重耐药鲍曼不动杆菌（MDRAB）感染的经验，尤其是用于治疗呼吸机相关性肺炎。
2008年2月至2008年7月在台北荣民总医院（台湾一家拥有2900张床位的三级医疗中心）回顾性收集接受替加环素治疗的患者。根据适应证将患者分为三组：第1组，美国食品药品监督管理局批准的适应证；第2组，医疗保健相关性肺炎（HAP）；第3组，尿路感染、骨髓炎、菌血症等。还确定了MDRAB病例。
66例患者中，替加环素的给药适应证包括美国食品药品监督管理局批准的适应证（12例，18.2%）、HAP（38例，57.6%）、菌血症（3例，4.5%）、导管相关感染（3例，4.5%）、尿路感染（4例，6.1%）、骨髓炎（4例，6.1%）及其他（2例，3%）。20例患者临床结局为阳性，第1组的临床成功率高于第2组，这可能与第2组序贯器官衰竭评估评分更高、年龄更大以及重症监护病房入住更频繁有关。在微生物学可评估的病例中，MDRAB占主导（33/51，64.7%）。在MDRAB感染（不包括无呼吸机的肺炎）中，临床成功率为12%（3/25）。
替加环素处方最常见的适应证是HAP。MDRAB感染的成功率低于先前报道，可能是因为我们的患者存在严重的基础疾病和合并症。由于选择有限，医生在开具替加环素处方时应权衡风险和获益。
