title: Tigecycline in the Treatment of Patients with Necrotizing Skin and Soft Tissue Infections Due to Multiresistant Bacteria.
abstract: BACKGROUND
  Necrotizing skin and soft tissue infections (NSTI) form a group of aggressive diseases that require radical debridement for infection control. Simultaneously, a high-dose broad spectrum antibiotic regimen needs to be initiated with control of septic complications in the intensive care setting. The aim of this work is to analyze the efficacy and safety of tigecycline in a subpopulation of hospitalized, severely ill surgical NSTI patients who were documented in a large multicenter non-interventional study on tigecycline use in routine clinical practice.
  
  
  METHODS
  A total of 1,025 patients with severe infections including complicated skin and soft-tissue infections (cSSTI, n=163; 15,9%) were enrolled in a prospective multi-center non-interventional study. Patients were to receive an initial intravenous dose of 100 mg tigecycline, followed by 50 mg twice daily. Prospectively documented parameters included clinical findings, APACHE II score, microbiological and standard laboratory assessments, surgical measures, and clinical outcomes including adverse events.
  
  
  RESULTS
  Of 163 patients were treated for cSSTI, with the largest subgroup being NSTI patients (n=50, 30.7% of all cSSTI, mean age 61 y, median APACHE II score 20). Forty-eight NSTI patients (96%) had at least one comorbidity. In 80% of patients, the treatment was started after previous antibiotic treatment had failed and in 34% resistant pathogens were isolated (28% methicillin resistant Staphyloccocus aureus [MRSA], 4% extended-spectrum-beta-lactamase (ESBL)-producing bacteria, and 2% vancomycin-resistant Enterococci (VRE). Tigecycline was administered as a single agent in 32 patients; 17 received combination regimens. Data from one patient were not reported. Rates of clinical cure or improvement with tigecycline treatment were 90.2%. Two patients (4%) had drug related adverse events (one thrombocytopenia and one fever/chills); 10 patients (20%) died.
  
  
  CONCLUSIONS
  Tigecycline alone or in combination therapy was an effective and safe antibiotic treatment in critically ill and antimicrobially pre-treated patients with NSTI frequently caused by resistant pathogens.
authors.affiliation: 1 Department of General, Visceral and Thoracic Surgery, Klinikum Peine Academic Hospital of Medical University Hannover , Germany .
authors.forename: Christian
authors.initials: C
authors.lastname: Eckmann
authors.affiliation: 2 Center of Microbiology and Infectiology , Berlin, Germany .
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Heizmann
authors.affiliation: 3 Klinikum Barnim GmbH, Werner Forßmann Hospital , Clinic of Medical Intensive Care and Interdisciplinary Emergency Care, Eberswalde, Germany .
authors.forename: Klaus-Friedrich
authors.initials: KF
authors.lastname: Bodmann
authors.affiliation: 4 Pfizer Pharma GmbH , Berlin, Germany .
authors.forename: Christoph
authors.initials: C
authors.lastname: von Eiff
authors.affiliation: 4 Pfizer Pharma GmbH , Berlin, Germany .
authors.forename: Christian
authors.initials: C
authors.lastname: Petrik
authors.affiliation: 4 Pfizer Pharma GmbH , Berlin, Germany .
authors.forename: Peter-Andreas
authors.initials: PA
authors.lastname: Loeschmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy*; D016638:Critical Illness; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011446:Prospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*; D000078304:Tigecycline; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline