Tigecycline Therapy for Infections Caused by Extended-Spectrum β-Lactamase-Producing <i>Enterobacteriaceae</i> in Critically Ill Patients

• Main Authors: Wen-Liang Yu, Nan-Yao Lee, Jann-Tay Wang, Wen-Chien Ko, Chung-Han Ho, Yin-Ching Chuang
• Format: Article
• Language: English
• Published: MDPI AG 2020-05-01
• Series: Antibiotics
• Subjects: Enterobacteriaceae; ESBL; carbapenem resistance; SOFA score; tigecycline
• Online Access: https://www.mdpi.com/2079-6382/9/5/231

<b>: </b>We aimed to evaluate tigecycline on the clinical effectiveness in treating complicated skin and soft tissue infections (cSSTI), complicated intra-abdominal infections (cIAI), and pneumonia, caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, as data are limited. From three medical centers in Taiwan, we retrospectively studied the cSSTI, cIAI, and/or pneumonia caused by ESBL-producing Enterobacteriaceae. Among the 71 patients, including 39 patients infected with <i>K</i><i>lebsiella</i><i> pneumoni</i><i>a</i><i>e</i>, 30 infected with <i>E</i><i>scherichia</i><i> coli</i> and others, the clinical success rate of tigecycline-based therapy was 80%–90% for pneumonia and cSSTI caused by <i>E. coli </i>and 50%–60% for cIAI caused by <i>K. pneumoniae </i>and<i> E. coli</i>. Microbiological and clinical outcome of pneumonia caused by carbapenem-resistant <i>K. pneumoniae</i> was poor. Univariate Cox analysis showed that dyspnea, SOFA score, septic shock, thrombocytopenia, prolonged prothrombin time, and lesser microbiological eradication were significant factors associated with 30-day mortality after the end of therapy. Cox regression proportional hazards model revealed dyspnea and a SOFA score > 8 to be independently associated with time to death. For ESBL producers, tigecycline showed good effects for cSSTI and pneumonia by <i>E</i><i>. coli</i>, ordinary for cIAI, but ineffective for pneumonia by <i>K. pneumoniae</i>. Dyspnea and a high SOFA score predict a poor outcome.