Katsiari Maria, Ntorlis Kyriakos, Nteves Ioannis, Roussou Zoi, Platsouka Evangelia D, Maguina Asimina
a Intensive Care Unit , Konstantopouleio General Hospital , Athens , Greece.
b Department of Microbiology , Konstantopouleio General Hospital , Athens , Greece.
J Chemother. 2016 Apr;28(2):110-5. doi: 10.1080/1120009X.2015.1118184. Epub 2016 Apr 11.
Tigecycline has a broad-spectrum in vitro activity against Gram-positive and Gram-negative bacteria, including multidrug-resistant (MDR) strains. However, some Gram-negative bacteria are intrinsically resistant or have reduced susceptibility to tigecycline. We performed a prospective, observational study of 43 patients who received tigecycline as the treatment for serious infections due to MDR Gram-negative microorganisms, to evaluate superinfections. In 60.5% of our patients, tigecycline-resistant (T-R) Gram-negative microorganisms were isolated, representing superinfection in 37.2% and colonization in 23.5%. Pseudomonas aeruginosa was the predominant pathogen (48.4%) followed by Providencia stuartii, Proteus mirabilis and Stenotrophomonas maltophilia. Median time elapsed between tigecycline prescription and isolation of T-R pathogens was 7 days. The 16 superinfections consisted of ventilator-associated pneumonias (43.75%), catheter-related bloodstream infections (37.5%), intra-abdominal infections (12.5%) and urinary tract infection (6.25%). Attributed mortality to superinfections was 31.25%. The comparison of various potential risk factors for isolation of T-R microorganisms did not reveal statistically significant results.
替加环素对革兰氏阳性菌和革兰氏阴性菌具有广谱体外活性，包括多重耐药（MDR）菌株。然而，一些革兰氏阴性菌对替加环素具有固有耐药性或敏感性降低。我们对43例接受替加环素治疗多重耐药革兰氏阴性微生物所致严重感染的患者进行了一项前瞻性观察性研究，以评估二重感染情况。在我们60.5%的患者中，分离出了对替加环素耐药（T-R）的革兰氏阴性微生物，其中37.2%为二重感染，23.5%为定植。铜绿假单胞菌是主要病原体（48.4%），其次是斯氏普罗威登斯菌、奇异变形杆菌和嗜麦芽窄食单胞菌。从替加环素处方到分离出T-R病原体的中位时间为7天。16例二重感染包括呼吸机相关性肺炎（43.75%）、导管相关血流感染（37.5%）、腹腔内感染（12.5%）和尿路感染（6.25%）。二重感染导致的死亡率为31.25%。对分离出T-R微生物的各种潜在风险因素进行比较，未得出具有统计学意义的结果。
