Papadimitriou-Olivgeris Matthaios, Bartzavali Christina, Nikolopoulou Alexandra, Kolonitsiou Fevronia, Mplani Virginia, Spiliopoulou Iris, Christofidou Myrto, Fligou Fotini, Marangos Markos
Division of Infectious Diseases, School of Medicine, University of Patras, 265 04 Patras, Greece.
Department of Microbiology, School of Medicine, University of Patras, 265 04 Patras, Greece.
Antibiotics (Basel). 2020 Nov 19;9(11):828. doi: 10.3390/antibiotics9110828.
Tigecycline is a therapeutic option for carbapenemase-producing (CP-Kp). Our aim was to evaluate the impact of the tigecycline's minimum inhibitory concentration (MIC) in the outcome of patients with CP-Kp bacteraemia treated with tigecycline monotherapy.
Patients with monomicrobial bacteraemia due to CP-Kp that received appropriate targeted monotherapy or no appropriate treatment were included. Primary outcome was 30-day mortality. MICs of meropenem, tigecycline, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. PCR for , , , and genes was applied.
Among 302 CP-Kp bacteraemias, 32 isolates (10.6%) showed MICs of tigecycline ≤ 0.5 mg/L, whereas 177 (58.6%) showed MICs that were 0.75-2 mg/L. Colistin and aminoglycoside susceptibility was observed in 43.0% and 23.8% of isolates, respectively. The majority of isolates carried (249; 82.5%), followed by (26; 8.6%), both and (16; 5.3%), and (11; 3.6%). Fifteen patients with tigecycline MIC ≤ 0.5 mg/L and 55 with MIC 0.75-2 mg/L were treated with tigecycline monotherapy; 30-day mortality was 20.0% and 50.9%, respectively ( = 0.042). Mortality of 150 patients that received other antimicrobials was 24.7%; among 82 patients that received no appropriate treatment, mortality was 39.0%. No difference in 30-day mortality was observed between patients that received tigecycline (MIC ≤ 0.5 mg/L) or other antimicrobials.
Tigecycline monotherapy was as efficacious as other antimicrobials in the treatment of bloodstream infections due to CP-Kp isolates with a tigecycline's MIC ≤ 0.5 mg/L.
替加环素是治疗产碳青霉烯酶肺炎克雷伯菌（CP-Kp）的一种治疗选择。我们的目的是评估替加环素的最低抑菌浓度（MIC）对接受替加环素单药治疗的CP-Kp菌血症患者预后的影响。
纳入因CP-Kp导致的单微生物菌血症且接受了适当的靶向单药治疗或未接受适当治疗的患者。主要结局是30天死亡率。美罗培南、替加环素和头孢他啶/阿维巴坦的MIC通过Etest测定，而对于黏菌素，则采用肉汤微量稀释法。应用针对blaKPC、blaNDM、blaVIM和blaOXA-48基因的PCR检测。
在302例CP-Kp菌血症中，32株分离菌（10.6%）的替加环素MIC≤0.5mg/L，而177株（58.6%）的MIC为0.75 - 2mg/L。分别有43.0%和23.8%的分离菌对黏菌素和氨基糖苷类敏感。大多数分离菌携带blaKPC（249株；82.5%），其次是blaNDM（26株；8.6%），blaKPC和blaNDM均携带（16株；5.3%），以及blaOXA-48（11株；3.6%）。15例替加环素MIC≤0.5mg/L和55例MIC为0.75 - 2mg/L的患者接受了替加环素单药治疗；30天死亡率分别为20.0%和50.9%（P = 0.042）。150例接受其他抗菌药物治疗的患者死亡率为24.7%；在82例未接受适当治疗的患者中，死亡率为39.0%。接受替加环素（MIC≤0.5mg/L）或其他抗菌药物治疗的患者之间30天死亡率无差异。
对于替加环素MIC≤0.5mg/L的CP-Kp分离菌引起的血流感染，替加环素单药治疗与其他抗菌药物疗效相当。
