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Clinical efficacy and safety of tigecycline based on therapeutic drug monitoring for carbapenem-resistant Gram-negative bacterium pneumonia in intensive care units

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机构： [1]Department of Pharmacy, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, No [45]Changchun Street, Xi Cheng District, Beijing 100053, China [2]Department of Intensive Medicine, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing 100053, China [3]Intensive Care Unit, Depart‑ment of Neurosurgery, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing 100053, China [4]Neurology Intensive Care Unit, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing 100053, China [5]Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing 100053, China [6]Central Laboratory of Xuanwu Hospital, Capital Medical University, Beijing 100053, China

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关键词： Tigecycline Therapeutic drug monitoring Multidrug-resistant Gram-negative bacteria Fibrinogen decline Pneumonia

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We investigated the associations between the different doses of tigecycline, its efficacy and safety, and the role of tigecycline therapeutic drug monitoring for patients in the intensive care unit.This study was a single-center cohort including patients infected with multidrug-resistant Acinetobacter baumannii (MDR-AB) and multidrug-resistant Klebsiella pneumoniae (MDR-KP) causing pulmonary infections. The steady-state plasma concentration after tigecycline administration was determined by High-Performance Liquid Chromatography (HPLC) in patients admitted to the ICU between October 2020 and December 2021. Multivariate analyses of tigecycline's clinical efficacy and safety were performed to control confounding factors.For this study, we included 45 patients and 45 blood samples to determine steady-state trough concentrations of tigecycline. All patients were divided into the High Dose (HD) and Standard Dose (SD) groups. The median trough concentration of tigecycline was 0.56 μg/mL in the HD group, which was higher than in the SD group (0,21 μg/mL), p = 0.000. There was no significant difference between the two groups of patients in terms of bacterial eradication rate, mortality rate, and clinical efficacy. Multiple regression analysis showed that the ICU days were correlated with mortality OR 1.030(1.005-1.056), p = 0.017. APACHE II was significantly associated with clinical efficacy OR 0.870(0.755-1.002), p = 0.045. The level of fibrinogen decline in the HD group was significantly higher than in the SD group (-3.05 ± 1.67 vs -1.75 ± 1.90), p = 0.038. We identified that age and tigecycline treatment duration influenced fibrinogen decline.Tigecycline plasma concentrations are significantly increased when using a high dose. However, the plasma concentration of tigecycline is not correlated with clinical efficacy and adverse reactions. Fibrinogen decline appears to be related to the patient's age and days of tigecycline. Large sample data are still needed to confirm the clinical guidance significance of tigecycline TDM.© 2023. The Author(s).

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出版当年[2022]版：

大类 | 3 区医学

小类 | 3 区传染病学

最新[2023]版：

大类 | 3 区医学

小类 | 3 区传染病学

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出版当年[2021]版：

Q3 INFECTIOUS DISEASES

最新[2023]版：

Q2 INFECTIOUS DISEASES

影响因子： 3.4 最新[2023版] 3.3 最新五年平均 3.669 出版当年[2021版] 3.714 出版当年五年平均 3.09 出版前一年[2020版] 3.7 出版后一年[2022版]

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第一作者机构： [1]Department of Pharmacy, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, No

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Clinical efficacy and safety of tigecycline based on therapeutic drug monitoring for carbapenem-resistant Gram-negative bacterium pneumonia in intensive care units

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