title: Clinical efficacy of tigecycline used as monotherapy or in combination regimens for complicated infections with documented involvement of multiresistant bacteria.
abstract: BACKGROUND
  Tigecycline is an established treatment option for infections with multiresistant bacteria (MRB). It retains activity against many strains with limited susceptibility to other antibiotics. Efficacy and safety of tigecycline as monotherapy or in combination regimens were investigated in a prospective noninterventional study involving 1,025 severely ill patients in clinical routine at 137 German hospitals.
  
  
  METHODS
  Data on the full population have been published; our present analysis focuses on infections caused by MRB. The study population included patients with complicated infections, high disease severity (APACHE II > 15: 65 %) and high MRB prevalence. Most patients had comorbidities, including cardiovascular disease, renal insufficiency, and/or diabetes mellitus. Treatment success was defined as cure/improvement without requirement of further antibiotic therapy.
  
  
  RESULTS
  Pathogens isolated from 215 evaluable patients with documented MRB infections included 132 methicillin-resistant Staphylococcus aureus (MRSA), 42 vancomycin-resistant Enterococci (VRE) and 67 Gram-negative extended beta-lactamase (ESBL) producers. Of the MRB subpopulation, 140 patients received tigecycline monotherapy, 75 were treated with combination regimens. High overall clinical success rates were recorded for MRB infections treated with tigecycline alone (94 %) or in combinations (88 %); in detail intraabdominal infections (monotherapy: 90 %; combinations: 93 %), skin/soft tissue infections (93; 100 %), community-acquired pneumonia (100; 100 %), hospital-acquired pneumonia (94,7; 72,7 %), diabetic foot infections (89; 33 %), blood stream infections (100; 100 %) and multiple-site infections (92; 71 %).
  
  
  CONCLUSIONS
  Tigecycline achieved high clinical success rates in patients with documented infections involving MRB strains despite high disease severity. These results add to the evidence indicating that tigecycline is a valuable therapeutic option for complicated infections in severely ill patients with a high likelihood of multidrug-resistant pathogen involvement.
authors.affiliation: Orgamed Laborsysteme GmbH, Maria-Schmid-Str. 14b, 94086, Bad Griesbach, Germany, wrheizmann@aol.com.
authors.forename: W R
authors.initials: WR
authors.lastname: Heizmann
authors.forename: P-A
authors.initials: PA
authors.lastname: Löschmann
authors.forename: C
authors.initials: C
authors.lastname: Eckmann
authors.forename: C
authors.initials: C
authors.lastname: von Eiff
authors.forename: K-F
authors.initials: KF
authors.lastname: Bodmann
authors.forename: C
authors.initials: C
authors.lastname: Petrik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D017719:Diabetic Foot; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D059413:Intraabdominal Infections; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D000078304:Tigecycline; D016896:Treatment Outcome; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects; D055815:Young Adult; D001618:beta-Lactamases
chemical_list: D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D001618:beta-Lactamases; D008911:Minocycline