Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study
Introduction Tigecycline is a potential alternative to trimethoprim–sulfamethoxazole in treating Stenotrophomonas maltophilia infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of S. maltophilia infections is scarce. In t...
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| Veröffentlicht in: | Infectious diseases and therapy 2021-12, Vol.10 (4), p.2415-2429 |
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| creator | Zha, Lei Zhang, Dayan Pan, Lingling Ren, Zhichu Li, Xiang Zou, Yi Li, Shirong Luo, Shuangqi Yang, Gang Tefsen, Boris |
| description | Introduction
Tigecycline is a potential alternative to trimethoprim–sulfamethoxazole in treating
Stenotrophomonas maltophilia
infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of
S. maltophilia
infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to
S. maltophilia
in comparison with fluoroquinolones.
Methods
This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by
S. maltophilia
receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed.
Results
Of 82 patients with
S. maltophilia
VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%,
p
= 0.009) and microbiological cure (28.6% vs. 59.1%,
p
= 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%,
p
= 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model.
Conclusions
The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with
S. maltophilia
VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating
S. maltophilia
VAP unless new clinical evidence emerges. |
| doi_str_mv | 10.1007/s40121-021-00516-5 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8354101</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A681599814</galeid><sourcerecordid>A681599814</sourcerecordid><originalsourceid>FETCH-LOGICAL-c518t-7d218cad8ea5f650073025aac803d4594bbdc79da7f0ebce9bffb740db13da093</originalsourceid><addsrcrecordid>eNp9UtuKFDEQbURxl3F_wKeAL770mkunO-2DMOx6gxVFR19DOqmeyZJOxiS9MB_hP5tmBnVFJBSVVM45VB2qqp4SfEkw7l6kBhNKarwE5qSt-YPqnJKe1S0T9OHpLijtz6qLlG4xLnjRkL57XJ2xhnVNz9l59WNjt6AP2lkPyHqUd4A2EVSewGcURvStZOtUDrFepxS0VRkM-uRhnoK3Cl3PgHJAXzL4kGPY70Kpq4Qm5XJ5WWfVS7RGH2aXrS5aENFnKMC0B53tHaCrsAsxF4HZHJ5Uj0blElyc8qr6-ub15updffPx7fur9U2tORG57gwlQisjQPGx5cUOhilXSgvMTMP7ZhiM7nqjuhHDoKEfxnHoGmwGwozCPVtVr466-3mYwCx9ReXkPtpJxYMMysr7P97u5DbcScF4QzApAs9PAjF8nyFlOdmkwTnlIcxJUt5i3DJcPF5Vz_6C3oY5-jKepKLtCO0a8gdqqxxI68diptKLqFy3gvC-F6QpqMt_oMoxMFkdPIy21O8R6JGgi-MpwvhrRoLlskfyuEcSL7HskVx6YUdSKmC_hfi74_-wfgI67sv-</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2867127415</pqid></control><display><type>article</type><title>Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study</title><source>DOAJ Directory of Open Access Journals</source><source>Springer Nature OA Free Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Zha, Lei ; Zhang, Dayan ; Pan, Lingling ; Ren, Zhichu ; Li, Xiang ; Zou, Yi ; Li, Shirong ; Luo, Shuangqi ; Yang, Gang ; Tefsen, Boris</creator><creatorcontrib>Zha, Lei ; Zhang, Dayan ; Pan, Lingling ; Ren, Zhichu ; Li, Xiang ; Zou, Yi ; Li, Shirong ; Luo, Shuangqi ; Yang, Gang ; Tefsen, Boris</creatorcontrib><description>Introduction
Tigecycline is a potential alternative to trimethoprim–sulfamethoxazole in treating
Stenotrophomonas maltophilia
infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of
S. maltophilia
infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to
S. maltophilia
in comparison with fluoroquinolones.
Methods
This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by
S. maltophilia
receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed.
Results
Of 82 patients with
S. maltophilia
VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%,
p
= 0.009) and microbiological cure (28.6% vs. 59.1%,
p
= 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%,
p
= 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model.
Conclusions
The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with
S. maltophilia
VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating
S. maltophilia
VAP unless new clinical evidence emerges.</description><identifier>ISSN: 2193-8229</identifier><identifier>EISSN: 2193-6382</identifier><identifier>DOI: 10.1007/s40121-021-00516-5</identifier><identifier>PMID: 34374953</identifier><language>eng</language><publisher>Cheshire: Springer Healthcare</publisher><subject>Analysis ; Antibiotics ; Bacterial pneumonia ; Care and treatment ; China ; Clinical outcomes ; Cohort analysis ; Drug dosages ; Health aspects ; Infectious Diseases ; Internal Medicine ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Mortality ; Original Research ; Pneumonia ; Ventilators</subject><ispartof>Infectious diseases and therapy, 2021-12, Vol.10 (4), p.2415-2429</ispartof><rights>The Author(s) 2021</rights><rights>COPYRIGHT 2021 Springer</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-7d218cad8ea5f650073025aac803d4594bbdc79da7f0ebce9bffb740db13da093</citedby><cites>FETCH-LOGICAL-c518t-7d218cad8ea5f650073025aac803d4594bbdc79da7f0ebce9bffb740db13da093</cites><orcidid>0000-0003-4897-0703</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354101/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354101/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,41120,42189,51576,53791,53793</link.rule.ids></links><search><creatorcontrib>Zha, Lei</creatorcontrib><creatorcontrib>Zhang, Dayan</creatorcontrib><creatorcontrib>Pan, Lingling</creatorcontrib><creatorcontrib>Ren, Zhichu</creatorcontrib><creatorcontrib>Li, Xiang</creatorcontrib><creatorcontrib>Zou, Yi</creatorcontrib><creatorcontrib>Li, Shirong</creatorcontrib><creatorcontrib>Luo, Shuangqi</creatorcontrib><creatorcontrib>Yang, Gang</creatorcontrib><creatorcontrib>Tefsen, Boris</creatorcontrib><title>Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study</title><title>Infectious diseases and therapy</title><addtitle>Infect Dis Ther</addtitle><description>Introduction
Tigecycline is a potential alternative to trimethoprim–sulfamethoxazole in treating
Stenotrophomonas maltophilia
infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of
S. maltophilia
infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to
S. maltophilia
in comparison with fluoroquinolones.
Methods
This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by
S. maltophilia
receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed.
Results
Of 82 patients with
S. maltophilia
VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%,
p
= 0.009) and microbiological cure (28.6% vs. 59.1%,
p
= 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%,
p
= 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model.
Conclusions
The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with
S. maltophilia
VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating
S. maltophilia
VAP unless new clinical evidence emerges.</description><subject>Analysis</subject><subject>Antibiotics</subject><subject>Bacterial pneumonia</subject><subject>Care and treatment</subject><subject>China</subject><subject>Clinical outcomes</subject><subject>Cohort analysis</subject><subject>Drug dosages</subject><subject>Health aspects</subject><subject>Infectious Diseases</subject><subject>Internal Medicine</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Mortality</subject><subject>Original Research</subject><subject>Pneumonia</subject><subject>Ventilators</subject><issn>2193-8229</issn><issn>2193-6382</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9UtuKFDEQbURxl3F_wKeAL770mkunO-2DMOx6gxVFR19DOqmeyZJOxiS9MB_hP5tmBnVFJBSVVM45VB2qqp4SfEkw7l6kBhNKarwE5qSt-YPqnJKe1S0T9OHpLijtz6qLlG4xLnjRkL57XJ2xhnVNz9l59WNjt6AP2lkPyHqUd4A2EVSewGcURvStZOtUDrFepxS0VRkM-uRhnoK3Cl3PgHJAXzL4kGPY70Kpq4Qm5XJ5WWfVS7RGH2aXrS5aENFnKMC0B53tHaCrsAsxF4HZHJ5Uj0blElyc8qr6-ub15updffPx7fur9U2tORG57gwlQisjQPGx5cUOhilXSgvMTMP7ZhiM7nqjuhHDoKEfxnHoGmwGwozCPVtVr466-3mYwCx9ReXkPtpJxYMMysr7P97u5DbcScF4QzApAs9PAjF8nyFlOdmkwTnlIcxJUt5i3DJcPF5Vz_6C3oY5-jKepKLtCO0a8gdqqxxI68diptKLqFy3gvC-F6QpqMt_oMoxMFkdPIy21O8R6JGgi-MpwvhrRoLlskfyuEcSL7HskVx6YUdSKmC_hfi74_-wfgI67sv-</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Zha, Lei</creator><creator>Zhang, Dayan</creator><creator>Pan, Lingling</creator><creator>Ren, Zhichu</creator><creator>Li, Xiang</creator><creator>Zou, Yi</creator><creator>Li, Shirong</creator><creator>Luo, Shuangqi</creator><creator>Yang, Gang</creator><creator>Tefsen, Boris</creator><general>Springer Healthcare</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4897-0703</orcidid></search><sort><creationdate>20211201</creationdate><title>Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study</title><author>Zha, Lei ; Zhang, Dayan ; Pan, Lingling ; Ren, Zhichu ; Li, Xiang ; Zou, Yi ; Li, Shirong ; Luo, Shuangqi ; Yang, Gang ; Tefsen, Boris</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c518t-7d218cad8ea5f650073025aac803d4594bbdc79da7f0ebce9bffb740db13da093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Analysis</topic><topic>Antibiotics</topic><topic>Bacterial pneumonia</topic><topic>Care and treatment</topic><topic>China</topic><topic>Clinical outcomes</topic><topic>Cohort analysis</topic><topic>Drug dosages</topic><topic>Health aspects</topic><topic>Infectious Diseases</topic><topic>Internal Medicine</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Mortality</topic><topic>Original Research</topic><topic>Pneumonia</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zha, Lei</creatorcontrib><creatorcontrib>Zhang, Dayan</creatorcontrib><creatorcontrib>Pan, Lingling</creatorcontrib><creatorcontrib>Ren, Zhichu</creatorcontrib><creatorcontrib>Li, Xiang</creatorcontrib><creatorcontrib>Zou, Yi</creatorcontrib><creatorcontrib>Li, Shirong</creatorcontrib><creatorcontrib>Luo, Shuangqi</creatorcontrib><creatorcontrib>Yang, Gang</creatorcontrib><creatorcontrib>Tefsen, Boris</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Infectious diseases and therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zha, Lei</au><au>Zhang, Dayan</au><au>Pan, Lingling</au><au>Ren, Zhichu</au><au>Li, Xiang</au><au>Zou, Yi</au><au>Li, Shirong</au><au>Luo, Shuangqi</au><au>Yang, Gang</au><au>Tefsen, Boris</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study</atitle><jtitle>Infectious diseases and therapy</jtitle><stitle>Infect Dis Ther</stitle><date>2021-12-01</date><risdate>2021</risdate><volume>10</volume><issue>4</issue><spage>2415</spage><epage>2429</epage><pages>2415-2429</pages><issn>2193-8229</issn><eissn>2193-6382</eissn><abstract>Introduction
Tigecycline is a potential alternative to trimethoprim–sulfamethoxazole in treating
Stenotrophomonas maltophilia
infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of
S. maltophilia
infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to
S. maltophilia
in comparison with fluoroquinolones.
Methods
This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by
S. maltophilia
receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed.
Results
Of 82 patients with
S. maltophilia
VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%,
p
= 0.009) and microbiological cure (28.6% vs. 59.1%,
p
= 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%,
p
= 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model.
Conclusions
The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with
S. maltophilia
VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating
S. maltophilia
VAP unless new clinical evidence emerges.</abstract><cop>Cheshire</cop><pub>Springer Healthcare</pub><pmid>34374953</pmid><doi>10.1007/s40121-021-00516-5</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0003-4897-0703</orcidid><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; Springer Nature OA Free Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Analysis Antibiotics Bacterial pneumonia Care and treatment China Clinical outcomes Cohort analysis Drug dosages Health aspects Infectious Diseases Internal Medicine Medical research Medicine Medicine & Public Health Medicine, Experimental Mortality Original Research Pneumonia Ventilators |
| title | Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study |
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