Objectives: To examine and report the use of Tigecycline (Wyeth) in the treatment of multidrug resistant acinetobacter (MDRA) culture positive sepsis in 11 patients requiring mutiorgan support. Methods: All patients were managed within the Liver Intensive Care Unit. Physiological data was collected prospectively and entered onto a specialist database. Patients received standard intensive care management; antibiotic and antifungal therapy administered as indicated by microbiological cultures. Systemic inflammatory response (SIRS) features initiated blood cultures (vascular lines and peripheral), drain fluid culture and broncoalveolar lavage (BAL). Screening swabs were undertaken weekly and samples sent for culture at laparotomy. MDRA positive cultures from blood, BAL, drain fluid or samples taken at laparotomy in the context of SIRS resulted in the initiation of tigecycline treatment. Results: 11 patients received Tigecycline treatment for MDRA infections. The underlying disease states were necrotizing pancreatitis (1), post hepatectomy (1), polytrauma (1), all with postive intra-abdominal cultures. Acute and acute on chronic liver failure (4), MDRA +ive broncho-alveolar lavage Â± blood cultures and 4 post liver transplant patients (necrotising pancreatitis in one, 2 with recurrent small bowel perforation and 1 with retroperitoneal haemorrhage) all with positive blood cultures and in 3 positive intraabdominal tissue/clot. Mean time from admission to treatment for MDRA was 25 days. Mean duration of treatment was 10 days (range 4-15). Mean APACHE II score at initiation of therapy was 18 (range 13-26); 4/11 patients survived to intensive care discharge and 3/11 to hospital discharge. Microbiological clearance of MDRA was observed in 8/11 cases. In those who did not achieve microbiological clearance cause of death was intra-abdominal haemorrhage, recalcitrant organ failure with recurrent small bowel perforation and vasopressor resistant shock. In these patients one remained culture positive for intraabdominal sepsis despite full treatment (small bowel perforation x5). The drug was well tolerated with the only side effect being that of hypercalcaemia observed in 5/12 patients, mean corrected calcium 2.59 mMol/l, range 2.32-2.81. In all cases this resolved on drug discontinuation. Conclusion: Tigecycline appears to be an efficacious agent in the treatment of deep seated MDRA infections.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)