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JAC Advance Access originally published online on January 21, 2009
Journal of Antimicrobial Chemotherapy 2009 63(4):775-780; doi:10.1093/jac/dkn555
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

A review of clinical and microbiological outcomes following treatment of infections involving multidrug-resistant Acinetobacter baumannii with tigecycline

N. C. Gordon1 and D. W. Wareham1,2,*

1 Division of Infection, Barts and The London NHS Trust, London, UK 2 Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK

Received 10 November 2008; returned 12 December 2008; revised 23 December 2008; accepted 27 December 2008

* Correspondence address. Centre for Infectious Disease, Institute of Cell and Molecular Science, 4 Newark Street, Whitechapel, London E1 2AT, UK. Tel: +44-20-7882-2317; Fax: +44-20-7882-2181; E-mail: d.w.wareham{at}qmul.ac.uk

Objectives: Multidrug-resistant Acinetobacter baumannii (MRAB) is an increasing problem in UK hospitals, with many strains now resistant to all available antibiotics except polymyxins. Tigecycline has been used for the treatment of MRAB as it demonstrates activity in vitro, but there are limited data on its clinical efficacy in Gram-negative infections, especially those involving the lower respiratory tract or bacteraemia.

Patients and methods: A retrospective study of the clinical and microbiological outcomes of all patients treated with tigecycline for MRAB over an 18 month period was undertaken.

Results: Thirty-four patients received tigecycline for MRAB or polymicrobial infection involving MRAB. Twenty-three (68%) had a positive clinical outcome: microbiological clearance was demonstrated in 10 of these. The overall mortality was 41% (n = 14), with nine deaths directly attributable to sepsis. Three patients had episodes of Gram-negative bacteraemia while receiving treatment with tigecycline, with documented resistance occurring in one patient. Overall, the correlation between microbiological and clinical outcomes was poor.

Conclusions: While tigecycline retains excellent in vitro activity against MRAB, its clinical efficacy remains uncertain. A prospective study, including the use of tigecycline in combination with other antimicrobial agents, should be undertaken to define its role in the treatment of MRAB.

Keywords: glycylcyclines , Gram-negative , polymicrobial infections


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