Niculae Cristian-Mihail, Gorea Maria-Evelina, Tirlescu Laura-Georgiana, Matoru Raluca-Mihaela, Hristea Adriana
Infectious Diseases, National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, ROU.
Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU.
Cureus. 2024 Jul 29;16(7):e65617. doi: 10.7759/cureus.65617. eCollection 2024 Jul.
There is existing controversy regarding the efficacy of tigecycline (TG) in treating complicated urinary tract infections (cUTIs) because of its pharmacokinetic concerns. We present three patients with cUTIs caused by carbapenem-resistant gram-negative (GN) pathogens successfully treated with high-dose tigecycline (HDT)-based regimens, as cefiderocol and aztreonam were not available in our country. The first case describes a 67-year-old patient with diabetes, prostate cancer, and double J ureteral stenting who was hospitalized with a febrile, complicated urinary tract infection (cUTI). Urine and blood cultures were positive for metallo-beta-lactamases (MBL)-producing extensively drug-resistant (XDR) (cefiderocol-susceptible). The synergy between TG and colistin using the in vitro E-test was demonstrated, and the patient was started on this regimen using HDT. Clinical and microbiological cures were achieved, and the patient was discharged home. The second case presents a 70-year-old patient with urethral pathology who was hospitalized with the diagnosis of a lower cUTI caused by an MBL-producing pan-drug-resistant (PDR) . The in vitro E-test showed synergy between TG and colistin, and our patient was successfully treated with this HDT-based combination. The third case emphasizes a 63-year-old patient with insulin-dependent diabetes, Child B cirrhosis, and a right double J ureteral stent who was hospitalized with a febrile cUTI. Urine and blood cultures were positive for carbapenem-resistant XDR (susceptible to colistin and TG). Colistin was administered for only 96 hours because of stage II acute kidney injury, and we continued the treatment with HDT in monotherapy. The patient was discharged home, and no urinary tract infection relapse was seen for six months. Favorable clinical and microbiological outcomes were achieved with TG-based regimens in our cUTI cases. We highlight the role of antibiotic synergy determined by the E-test in two cases of MBL-producing XDR/PDR .
由于药代动力学方面的问题，替加环素（TG）治疗复杂性尿路感染（cUTIs）的疗效存在争议。我们报告了3例由耐碳青霉烯革兰阴性（GN）病原体引起的cUTIs患者，因我国无法获得头孢地尔和氨曲南，采用基于高剂量替加环素（HDT）的方案成功治疗。第一例描述了一名67岁患有糖尿病、前列腺癌和双J输尿管支架置入的患者，因发热性复杂性尿路感染（cUTI）住院。尿液和血液培养显示产金属β-内酰胺酶（MBL）的广泛耐药（XDR）（对头孢地尔敏感）。通过体外E试验证明了TG与黏菌素之间的协同作用，患者开始使用HDT方案治疗。实现了临床和微生物学治愈，患者出院回家。第二例是一名70岁患有尿道病变的患者，因产MBL的全耐药（PDR）导致下cUTI而住院。体外E试验显示TG与黏菌素之间具有协同作用，该患者通过这种基于HDT的联合治疗成功治愈。第三例强调了一名63岁患有胰岛素依赖型糖尿病、Child B级肝硬化和右侧双J输尿管支架置入的患者，因发热性cUTI住院。尿液和血液培养显示耐碳青霉烯XDR（对黏菌素和TG敏感）。由于II期急性肾损伤，仅给予黏菌素96小时，我们继续采用HDT单药治疗。患者出院回家，六个月内未见尿路感染复发。在我们的cUTI病例中，基于TG的方案取得了良好的临床和微生物学结果。我们强调了E试验确定的抗生素协同作用在两例产MBL的XDR/PDR病例中的作用。
