title: Tigecycline for treatment of carbapenem-resistant Klebsiella pneumoniae infections after liver transplantation in the intensive care unit: a 3-year study.
abstract: BACKGROUND
  This 3-year prospective, observational, single-center study was undertaken to describe prescription, microbiology findings, tolerance, and efficacy of tigecycline for carbapenem-resistant Klebsiella pneumoniae (CRKP) infections after liver transplantation in the intensive care unit (ICU).
  
  
  METHODS
  All patients after liver transplantation treated with tigecycline for ≥3 days for CRKP infections in our ICU from January 1, 2010, to December 31, 2012, were studied. Patient characteristics, indication of treatment, bacteriology, and ICU mortality were collected. The main end points were clinical and microbiologic efficacy and tolerance of tigecycline.
  
  
  RESULTS
  Over the study period, 8 men and 2 women (18 CRKP isolates), aged 54.3 ± 7.7 years, were included in the study. Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores on ICU admission were 13.7 ± 2.7 and 10 ± 2.2, respectively. In 7 isolates, tigecycline was prescribed for CRKP blood stream infection (BSI), in 6 for complicated intra-abdominal infection (IAI), in 2 for ventilator-associated pneumonia (VAP), in 2 for surgical site infection, and in 1 for urinary tract infection. In 4 cases, tigecycline was prescribed for secondary BSI followed by VAP and/or IAI. All isolates were susceptible to tigecycline, 83.4% to colistin, 44.5% to gentamicin, and 27.8% to amikacin. In 2 patients, tigecycline was prescribed as monotherapy. Three patients had clinical failure. The microbiologic response rate was 70%. Superinfection was detected in 5 patients, and Pseudomonas aeruginosa was the most frequently isolated pathogen. Tigecycline was generally well tolerated. The ICU mortality rate was 60% with attributable mortality rate 30%.
  
  
  CONCLUSIONS
  Our pilot study suggests that tigecycline shows a good safety and tolerance profile in patients with CRKP infections in the ICU after orthotopic liver transplantation. Limited therapeutic options for such infections leave physicians no choice but to use tigecycline for off-label indications such as urinary tract and blood stream infections.
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece. Electronic address: elmoulou@yahoo.gr.
authors.forename: E
authors.initials: E
authors.lastname: Mouloudi
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Massa
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Piperidou
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Papadopoulos
authors.affiliation: Infection Control Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Iosifidis
authors.affiliation: Infection Control Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Roilides
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: T
authors.initials: T
authors.lastname: Theodoridou
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Kydona
authors.affiliation: Transplantation Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Fouzas
authors.affiliation: Transplantation Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Imvrios
authors.affiliation: Transplantation Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Papanikolaou
authors.affiliation: Intensive Care Unit, "Hippokratio" University Hospital, Thessaloniki, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Gritsi-Gerogianni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D000078304:Tigecycline; D013997:Time Factors; D016896:Treatment Outcome; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000078304:Tigecycline; D008911:Minocycline