title: Life-threatening coagulopathy and hypofibrinogenaemia induced by tigecycline in a patient with advanced liver cirrhosis.
abstract: Bacterial infections because of multidrug-resistant (MDR) bacteria are spreading worldwide. In patients with advanced liver cirrhosis, healthcare-acquired and hospital-acquired infections are common and are frequently sustained by MDR bacteria. In these settings, tigecycline, a new antibiotic, has been shown to be useful in the treatment of MDR bacteria, and it has been proposed for the treatment of hospital-acquired infections in patients with cirrhosis. Nevertheless, poor data exist on the safety profile of tigecycline in patients with cirrhosis. Here, an experience is reported in a female patient with advanced liver cirrhosis, who developed sepsis by an MDR Stenotrophomonas maltophilia and was treated with tigecycline. She experienced life-threatening side effects consisting of severe coagulopathy with hypofibrinogenaemia and subsequent gastrointestinal haemorrhage. The side effect disappeared after the withdrawal of tigecycline. Therefore, a strict monitoring of coagulation parameters in patients with cirrhosis treated with tigecycline is recommended.
authors.affiliation: Departments of aMedicine (DIMED) bCardiologic Thoracic and Vascular Sciences cUnit of Hepatic Emergencies and Liver Transplantation, University of Padova, Padova, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Rossitto
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piano
authors.forename: Silvia
authors.initials: S
authors.lastname: Rosi
authors.forename: Paolo
authors.initials: P
authors.lastname: Simioni
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
mesh_terms: D000328:Adult; D000347:Afibrinogenemia / Q000139:chemically induced; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001778:Blood Coagulation Disorders / Q000139:chemically induced*; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008911:Minocycline / Q000009:adverse effects / Q000031:analogs & derivatives*; D009894:Opportunistic Infections / Q000150:complications / Q000188:drug therapy; D020615:Stenotrophomonas maltophilia / Q000276:immunology; D000078304:Tigecycline
chemical_list: D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline