title: 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.
abstract: BACKGROUND
  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 ≥ 48 h 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-72 h (207.4 ± 87.9 vs. 163.7 ± 76.8, p = 0.021). In the multivariate analysis (R2 = 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-72 h (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.
authors.affiliation: Emilio Maseda, Anesthesiology and Surgical Critical Care Department. Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. emilio.maseda@gmail.com.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maseda
authors.forename: Alejandro
authors.initials: A
authors.lastname: Suárez-de-la-Rica
authors.forename: Víctor
authors.initials: V
authors.lastname: Anillo
authors.forename: Patricia
authors.initials: P
authors.lastname: Salgado
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tamayo
authors.forename: Carlos A
authors.initials: CA
authors.lastname: García-Bernedo
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramasco
authors.forename: María-José
authors.initials: MJ
authors.lastname: Villagrán
authors.forename: Araceli
authors.initials: A
authors.lastname: López-Tofiño
authors.forename: María-José
authors.initials: MJ
authors.lastname: Giménez
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Granizo
authors.forename: Carmen
authors.initials: C
authors.lastname: Hernández-Gancedo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
authors.forename: Fernando
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003422:Critical Care; D016638:Critical Illness; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology; D000078304:Tigecycline
chemical_list: D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline