A practice-based observational study identifying factors associated with the use of high-dose tigecycline in the treatment of secondary peritonitis in severely ill patients

作者：Maseda Emilio^*; Suarez de la Rica Alejandro; Anillo Victor; Salgado Patricia; Tamayo Eduardo; Garcia Bernedo Carlos A; Ramasco Fernando; Villagran Maria Jose; Lopez Tofino Araceli; Gimenez Maria Jose; Granizo Juan Jose; Hernandez Gancedo Carmen; Aguilar Lorenzo; Gilsanz Fernando

来源：Revista Espanola de Quimioterapia, 2015, 28(1): 47-53.

• Secondary peritonitis
• multidrug treatment regimen
• post-surgical critical care
• tigecycline
• critically ill patients

Introduction. Based on tigecycline linear pharmacokinetic/ pharmacodynamics, dose increases have been advocated to maximise activity especially when severe infections with high bacterial load and/or multidrug resistance are suspected. This practice-based observational study explored factors associated with tigecycline administration (100 mg/12h, 200 mg loading dose) in severely ill patients with complicated intra-abdominal infection (cIAI) admitted to four Surgical Critical Care Units (SCCUs).
Methods. Medical records of all consecutive adult patients with cIAI and controlled infection source requiring surgery and admission for >= 48h to SCCU were reviewed and divided into patients treated with a regimen including tigecycline (tigecycline group) and those that not (control group). A logistic regression model was performed using "tigecycline administration" (dependent variable) and variables showing differences (p <= 0.1) in bivariate analyses (independent variables).
Results. One hundred and twenty one patients were included. In the tigecycline group, higher percentage of patients (vs. controls) presented colon as surgical site (66.7% vs. 41.8%, p=0.006), nosocomial infection (55.6% vs. 26.9%, p=0.001), mechanical ventilation (48.1% vs. 28.4%, p=0.025), chronic renal replacement therapy (40.7% vs. 19.4%, p=0.008), septic shock (72.2% vs. 46.3%, p=0.004), and higher values of SAPS II (48.0 +/- 15.0 vs. 39.6 +/- 15.5, p=0.003), SOFA at admission (7.0 +/- 3.3 vs. 5.5 +/- 3.7, p=0.020), lactate-24h (2.5 +/- 2.8 vs. 1.6 +/- 0.9, p=0.029) and CRP-72h (207.4 +/- 87.9 vs. 163.7 +/- 76.8, p=0.021). In the multivariate analysis (R-2=0.187, p<0.001) nosocomial infection (OR=7.721; 95% CI=2.193, 27.179; p=0.001), colon as infection site (OR=4.338; 95% CI=1.432, 13.145; p=0.009) and CRP-72h (OR=1.009 per-unit; 95% CI=1.002, 1.016; p=0.012) were associated with tigecycline administration.
Conclusions. In severely ill patients with cIAI, high-dose tigecycline administration was associated with nosocomial origin of cIAI and colon as source infection site.

• 出版日期2015-2