JAC Advance Access originally published online on November 1, 2006
Journal of Antimicrobial Chemotherapy 2007 59(1):128-131; doi:10.1093/jac/dkl441
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acinetobacter baumannii bloodstream infection while receiving tigecycline: a cautionary report
1 Division of Infectious Diseases, University of Pittsburgh Medical Center Pittsburgh, PA 15213, USA 2 Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy and University of Pittsburgh Medical Center Pittsburgh, PA 15213, USA 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center Pittsburgh, PA 15213, USA
Received 23 June 2006; returned 2 August 2006; revised 5 October 2006; accepted 6 October 2006
*Corresponding author. Tel: +1-412-648-6478; Fax: +1-412-648-6399; E-mail: patersond{at}dom.pitt.edu
Objectives: Tigecycline has shown in vitro activity against Acinetobacter baumannii. Yet, published clinical experience with tigecycline use outside clinical trials is lacking. We describe, for the first time, bloodstream infection caused by tigecycline-non-susceptible A. baumannii occurring in patients receiving tigecycline for other indications. The possible mechanisms of resistance and pharmacokinetic limitations of the drug are addressed.
Methods: The clinical records of involved patients were systematically reviewed. Tigecycline susceptibility testing was initially performed using the Etest method and confirmed by agar dilution. Involved isolates underwent PFGE and exposure to phenyl-arginine-ß-naphthylamide (PAßN), an efflux pump inhibitor.
Results: Two patients developed A. baumannii bloodstream infection while receiving tigecycline. Tigecycline was administered for other indications for 9 and 16 days, respectively, before the onset of A. baumannii infection. Patient 1 died of overwhelming A. baumannii infection and Patient 2 recovered after a change in antibiotic therapy. The MICs of tigecycline were 4 and 16 mg/L, respectively. Both isolates had a multidrug-resistant phenotype and were genotypically unrelated. After exposure to PAßN, the MICs reduced to 1 and 4 mg/L, respectively.
Conclusions: To our knowledge, this is the first clinical description of bloodstream infection caused by tigecycline-non-susceptible A. baumannii. Such resistance appears to be at least partly attributable to an efflux pump mechanism. Given the reported low serum tigecycline levels, we urge caution when using this drug for treatment of A. baumannii bloodstream infection.
Keywords: A. baumannii , glycylcycline , GAR-936 , antibiotic resistance
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P.-L. Lu, M. Doumith, D. M. Livermore, T.-P. Chen, and N. Woodford Diversity of carbapenem resistance mechanisms in Acinetobacter baumannii from a Taiwan hospital: spread of plasmid-borne OXA-72 carbapenemase J. Antimicrob. Chemother., April 1, 2009; 63(4): 641 - 647. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Arroyo, I. Mateos, V. Gonzalez, and J. Aznar In Vitro Activities of Tigecycline, Minocycline, and Colistin-Tigecycline Combination against Multi- and Pandrug-Resistant Clinical Isolates of Acinetobacter baumannii Group Antimicrob. Agents Chemother., March 1, 2009; 53(3): 1295 - 1296. [Full Text] [PDF]
|
|
|
|
|
|
D. C. Bean and D. W. Wareham Paradoxical effect of 1-(1-naphthylmethyl)-piperazine on resistance to tetracyclines in multidrug-resistant Acinetobacter baumannii J. Antimicrob. Chemother., February 1, 2009; 63(2): 349 - 352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Hawkey The growing burden of antimicrobial resistance J. Antimicrob. Chemother., September 1, 2008; 62(suppl_1): i1 - i9. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C Gallagher and H. M Rouse Tigecycline for the Treatment of Acinetobacter Infections: A Case Series Ann. Pharmacother., September 1, 2008; 42(9): 1188 - 1194. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Moland, D. W. Craft, S.-g. Hong, S.-y. Kim, L. Hachmeister, S. D. Sayed, and K. S. Thomson In Vitro Activity of Tigecycline against Multidrug-Resistant Acinetobacter baumannii and Selection of Tigecycline-Amikacin Synergy Antimicrob. Agents Chemother., August 1, 2008; 52(8): 2940 - 2942. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Valentine, D. Contreras, S. Tan, L. J. Real, S. Chu, and H. H. Xu Phenotypic and Molecular Characterization of Acinetobacter baumannii Clinical Isolates from Nosocomial Outbreaks in Los Angeles County, California J. Clin. Microbiol., August 1, 2008; 46(8): 2499 - 2507. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Y. Peleg, H. Seifert, and D. L. Paterson Acinetobacter baumannii: Emergence of a Successful Pathogen Clin. Microbiol. Rev., July 1, 2008; 21(3): 538 - 582. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Karageorgopoulos, T. Kelesidis, I. Kelesidis, and M. E. Falagas Tigecycline for the treatment of multidrug-resistant (including carbapenem-resistant) Acinetobacter infections: a review of the scientific evidence J. Antimicrob. Chemother., July 1, 2008; 62(1): 45 - 55. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. S. Munoz-Price and R. A. Weinstein Acinetobacter Infection N. Engl. J. Med., March 20, 2008; 358(12): 1271 - 1281. [Full Text] [PDF]
|
|
|
|
|
|
C. G. Giske, D. L. Monnet, O. Cars, Y. Carmeli, and on behalf of ReAct-Action on Antibiotic Resistance Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli Antimicrob. Agents Chemother., March 1, 2008; 52(3): 813 - 821. [Full Text] [PDF]
|
|
|
|
|
|
L. Damier-Piolle, S. Magnet, S. Bremont, T. Lambert, and P. Courvalin AdeIJK, a Resistance-Nodulation-Cell Division Pump Effluxing Multiple Antibiotics in Acinetobacter baumannii Antimicrob. Agents Chemother., February 1, 2008; 52(2): 557 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Perez, A. M. Hujer, K. M. Hujer, B. K. Decker, P. N. Rather, and R. A. Bonomo Global Challenge of Multidrug-Resistant Acinetobacter baumannii Antimicrob. Agents Chemother., October 1, 2007; 51(10): 3471 - 3484. [Full Text] [PDF]
|
|
|
|
|
|
K. Yang and B J. Guglielmo Diagnosis and Treatment of Extended-Spectrum and AmpC {beta}-Lactamase-Producing Organisms Ann. Pharmacother., September 1, 2007; 41(9): 1427 - 1435. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Y. Peleg, J. Adams, and D. L. Paterson Tigecycline Efflux as a Mechanism for Nonsusceptibility in Acinetobacter baumannii Antimicrob. Agents Chemother., June 1, 2007; 51(6): 2065 - 2069. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M Slover, K. A Rodvold, and L. H Danziger Tigecycline: A Novel Broad-Spectrum Antimicrobial Ann. Pharmacother., June 1, 2007; 41(6): 965 - 972. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Iredell, L. Thomas, D. Power, and E. Mendes Tigecycline resistance in Australian antibiotic-resistant Gram-negative bacteria J. Antimicrob. Chemother., April 1, 2007; 59(4): 816 - 818. [Full Text] [PDF]
|
|
|
|
|
|
S. Navon-Venezia, A. Leavitt, and Y. Carmeli High tigecycline resistance in multidrug-resistant Acinetobacter baumannii J. Antimicrob. Chemother., April 1, 2007; 59(4): 772 - 774. [Abstract] [Full Text] [PDF]
|
|