Department of Internal Medicine, Service of Endocrinology, American Hospital, Tirane, Albania.
Service of Infection Diseases, University Hospital Center, Tirane, Albania.
J Infect Dev Ctries. 2024 Jul 29;18(7):1157-1160. doi: 10.3855/jidc.18229.
Tigecycline has a broad spectrum of activity, including activity against drug-resistant Gram-positive and -negative microorganisms. Its side effects are significant, but hypoglycemia is a rare finding during treatment. We aim to present an event of severe hypoglycemia in a patient with type 2 diabetes mellitus with replacement renal therapy, and hemodialysis after initiating tigecycline.
A 54-year-old female diagnosed with type 2 diabetes mellitus was under treatment with basal-bolus insulin therapy and oral antihypertensive drugs. She started hemodialysis 24 months ago. She complained of recurrent fever for the last seven months and was treated with several antibiotics. In two separate blood cultures, she tested positive for methicillin-resistant Staphylococcus epidermidis (MRSE). Based on the antibiogram, we started treatment with tigecycline 100 mg/day. After 6-8 hours from the first dose, the patient is complicated with events of hypoglycemia and then continues with severe hypoglycemia (40-47 mg/dL). The patient continued to have hypoglycemia for about 16-18 hours after the last dose. We didn't find any reasons to explain the cause of episodes of hypoglycemia. She did not have high blood insulin levels (insulin 4.11 mIU/L [range 2.6-24.9]). We followed her for six months and the patient did not experience episodes of hypoglycemia.
The association of severe hypoglycemia with tigecycline treatment is a very rare event and published papers on this topic are limited. Clinicians should be aware of this rare event when administering tigecycline and should routinely check blood glucose level during the treatment.
替加环素具有广泛的活性，包括对耐药革兰氏阳性和阴性微生物的活性。其副作用显著，但在治疗过程中低血糖是一种罕见的发现。我们旨在报告一例 2 型糖尿病伴替代肾治疗和开始使用替加环素后行血液透析的患者发生严重低血糖的事件。
一名 54 岁女性，诊断为 2 型糖尿病，接受基础-餐时胰岛素治疗和口服降压药物治疗。她在 24 个月前开始行血液透析。她在过去七个月反复发热，接受了几种抗生素治疗。在两次单独的血培养中，她对耐甲氧西林表皮葡萄球菌（MRSE）检测呈阳性。根据药敏试验结果，我们开始使用替加环素 100mg/天治疗。首次剂量后 6-8 小时，患者出现低血糖事件，并随后出现严重低血糖（40-47mg/dL）。在最后一次剂量后，患者大约有 16-18 小时持续出现低血糖。我们没有发现任何可以解释低血糖发作原因的证据。她没有高胰岛素血症（胰岛素 4.11mIU/L[范围 2.6-24.9]）。我们对她进行了六个月的随访，患者没有再次出现低血糖。
替加环素治疗严重低血糖的相关性是一种非常罕见的事件，并且关于该主题的已发表论文有限。临床医生在使用替加环素时应注意这一罕见事件，并应在治疗过程中常规检查血糖水平。
