TY - JOUR
T1 - Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia
T2 - A Multicenter Retrospective Cohort Study
AU - Zha, Lei
AU - Zhang, Dayan
AU - Pan, Lingling
AU - Ren, Zhichu
AU - Li, Xiang
AU - Zou, Yi
AU - Li, Shirong
AU - Luo, Shuangqi
AU - Yang, Gang
AU - Tefsen, Boris
N1 - Funding Information:
The study, including the Journal’s Rapid Service Fees, was funded by Conch Hospital of Anhui Medical University (Wuhu, Anhui, China) as part of the research project on multidrug resistant bacteria (F20190301).
Funding Information:
The study, including the Journal?s Rapid Service Fees, was funded by Conch Hospital of Anhui Medical University (Wuhu, Anhui, China) as part of the research project on multidrug resistant bacteria (F20190301). All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Design of Study and Conceptualization: Lei Zha and Boris Tefsen. Data Collection: Dayan Zhang, Zhichu Ren, Xiang Li, Yi Zou, Shirong Li, Gang Yang, Shuangqi Luo and Lingling Pan. Data analysis: Lei Zha, Dayan Zhang and Lingling Pan. Original Draft Construction: Lei Zha. Draft Review and Scientific Revisions: Boris Tefsen. Final draft approval: Lei Zha, Dayan Zhang, Lingling Pan, Zhichu Ren, Xiang Li, Yi Zou, Shirong Li, Shuangqi Luo, Gang Yang, and Boris Tefsen. Lei Zha, Dayan Zhang, Lingling Pan, Zhichu Ren, Xiang Li, Yi Zou, Shirong Li, Shuangqi Luo, Gang Yang, and Boris Tefsen have none to declare. The study was approved by the ethics committee of Xi?an Jiaotong-Liverpool University (reference number 19-01-05) and the institutional review board in each participating hospital, The First People?s Hospital of Wuhu (approval number 202001), The Second People?s Hospital of Wuhu (approval number 2019-04) and The First Affiliated Hospital of Wannan Medical College (reference number 2019-97). The patient?s medical records and information were anonymized and deidentified prior to analysis. The datasets generated and analyzed during the current study are available from the corresponding author (Lei Zha) on reasonable request.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - Fluoroquinolones
KW - Levofloxacin
KW - Moxifloxacin
KW - Multicenter retrospective cohort study
KW - Stenotrophomonas maltophilia
KW - Tigecycline
KW - Ventilator-associated pneumonia
UR - http://www.scopus.com/inward/record.url?scp=85112151742&partnerID=8YFLogxK
U2 - 10.1007/s40121-021-00516-5
DO - 10.1007/s40121-021-00516-5
M3 - Article
AN - SCOPUS:85112151742
SN - 2193-8229
VL - 10
SP - 2415
EP - 2429
JO - Infectious Diseases and Therapy
JF - Infectious Diseases and Therapy
IS - 4
ER -
