Xia Guolian, Jiang Ronglin
Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China.
Medicine (Baltimore). 2020 Mar;99(10):e19466. doi: 10.1097/MD.0000000000019466.
Multidrug-resistant bacterial (MDRB) infections have been difficult to treat clinically. Tigecycline (TIG) has several advantages, especially in the treatment of severe infections. Many clinicians have considered increasing the TIG dose to improve the efficacy of this molecule. The safety and efficacy of high-dose TIG in elderly patients with MDRB infections were investigated in this study.We conducted a retrospective analysis of the elderly patients with MDRB infections who were treated at the First Affiliated Hospital. A total of 106 patients received a conventional dose (CD-TIG group: 50 mg every 12 hours) of TIG and 51 received a high dose (HD-TIG group: 100 mg every 12 hours). The data from all patients were collected for examining the clinical features and performing the microbiological analysis. The safety profile and efficacy of the HD regimen were investigated.The clinical efficacy and microbiological eradication in the patients with MDRB infection were higher in the HD-TIG group than the CD-TIG group. The independent predictors of clinical cure were the use of TIG at HD (odd ratio [OR], 5.129; 95% confidence interval [CI] [1.890, 13.921]; P = .001) and microbiological eradication (OR, 3.049; 95% CI, [1.251, 7.430]; P = .014). In the ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) subgroups, the sole independent predictor of clinical cure was the HD of TIG, and no significant adverse events were observed. The occurrence of multidrug-resistant Acinetobacter baumannii infection and an MIC value of 1 to 2 g/mL for TIG were independently associated with clinical failure in the VAP subgroup.HDs of TIG was found to associate with better clinical efficacy and microbiological eradication than its CDs in the elderly patients with MDRB infections. In the VAP and BSIs subgroups, administration of HDs of TIG was associated with better outcomes.
耐多药细菌（MDRB）感染在临床上一直难以治疗。替加环素（TIG）具有多种优势，尤其是在治疗严重感染方面。许多临床医生考虑增加替加环素剂量以提高该药物分子的疗效。本研究对老年耐多药细菌感染患者使用高剂量替加环素的安全性和疗效进行了调查。我们对在第一附属医院接受治疗的老年耐多药细菌感染患者进行了回顾性分析。共有106例患者接受了常规剂量的替加环素（CD-TIG组：每12小时50毫克），51例接受了高剂量的替加环素（HD-TIG组：每12小时100毫克）。收集所有患者的数据以检查临床特征并进行微生物学分析。研究了高剂量方案的安全性和疗效。HD-TIG组耐多药细菌感染患者的临床疗效和微生物清除率高于CD-TIG组。临床治愈的独立预测因素是高剂量使用替加环素（比值比[OR]，5.129；95%置信区间[CI][1.890,13.921]；P = 0.001）和微生物清除（OR，3.049；95%CI，[1.251,7.430]；P = 0.014）。在呼吸机相关性肺炎（VAP）和血流感染（BSI）亚组中，临床治愈的唯一独立预测因素是高剂量的替加环素，且未观察到明显不良事件。耐多药鲍曼不动杆菌感染的发生以及替加环素的最低抑菌浓度（MIC）值为1至2微克/毫升与VAP亚组的临床失败独立相关。在老年耐多药细菌感染患者中，发现高剂量替加环素比常规剂量具有更好的临床疗效和微生物清除率。在VAP和BSI亚组中，高剂量替加环素的给药与更好的结果相关。
