Resumen de Analysis of treatment failure with standard and high dose of tigecycline in critically ill patients with multidrug-resistant bacteria

Jesús Ruiz Ramos, Pablo Pérez Huertas, Esther Villarreal Tello, M. Gordón, Adrián Quinzá, Paula Ramírez Galleymore

• Objectives: The emergence of multidrug-resistant (MDR) bacteria has created a challenge in the treatment of nosocomial infection. Serious concern has risen regarding the possible treatment failure with the standard tigecycline regimen. The aim of this study is to describe tigecycline outcomes in critically ill patients and to identify possible factors related with tigecycline treatment failure. Method: We designed a retrospective study. Critically ill patients infected by MDR gram negative bacteria who received tigecycline from January 2010 to March 2016 were included. Primary endpoints were clinical and microbiological outcomes and 30-day mortality. Differences between high (100 mg/12h) and standard (50 mg/12h) dose in main outcomes were evaluated. Results and discussion: 46 patients were included in the analysis, 38 (78.3%) of them had received previous antimicrobial therapy. Clinical response was observed in 19 (41.3%) patients and clinical failure in 23 (50%). Mortality rate at day 30 was 39.3% (No. = 18). No significant differences were found in clinical or microbiological treatment failure and in 30-day mortality between high dose and standard dose. In the multivariate analysis, neutropenia was significantly associated with 30-day mortality [OR: 7.66 (1.53-38.32)] and clinical failure [OR: 5.44 (0.96-30.77)]. Conclusion: Treatment with tigecycline in critical patients previously treated with other antibiotics is associated with a high risk of treatment failure. Benefit and risk should be considered, especially in off-label settings lung infection and patients with neutropeni