title: Tigecycline treatment experience against multidrug-resistant Acinetobacter baumannii infections: a systematic review and meta-analysis.
abstract: The role of tigecycline in treating multidrug-resistant Acinetobacter baumannii (MDR-AB) infections remains controversial. A systematic review and meta-analysis was performed to assess the efficacy and safety of tigecycline in treating MDR-AB infections. PubMed, Embase and Cochrane Library databases were searched up to 20 September 2015. Studies evaluating the efficacy and/or safety of tigecycline in treating MDR-AB infections were included. PRISMA guidelines were followed and the I(2) method was used for heterogeneity. Seven controlled and seventeen single-arm studies were included. No significant difference was noted when tigecycline was compared with control groups in terms of all-cause mortality (OR=0.87, 95% CI 0.50-1.52; P=0.63) and clinical response (OR=1.58, 95% CI 0.61-4.05; P=0.34). Subgroup analysis indicated that treatment with tigecycline was associated with higher in-hospital mortality (OR=1.57, 95% CI 1.04-2.35; P=0.03). Compared with controls, tigecycline had a significantly lower microbial eradication rate (OR=0.20, 95% CI 0.07-0.59; P=0.003) and trend for longer hospital stay (mean difference, 4.69 days, 95% CI -0.17 to 9.55 days; P=0.06). In comparison with monotherapy, tigecycline combination therapy did not affect mortality, clinical response or microbiological response. Tigecycline was well tolerated in the patient populations studied. The pooled rates of resistance emergence and superinfection during treatment were 12.47% and 19.11%, respectively. These findings disfavour the use of a tigecycline-based regimen for the treatment of MDR-AB infections. Well-designed RCTs are needed to clarify the role of tigecycline for MDR-AB infections.
authors.affiliation: Department of Respiratory Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China.
authors.forename: Wentao
authors.initials: W
authors.lastname: Ni
authors.affiliation: Department of Neurology, Chinese PLA 305 Hospital, Beijing 100017, China.
authors.forename: Yuliang
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Respiratory Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Respiratory Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China.
authors.forename: Chuanqi
authors.initials: C
authors.lastname: Wei
authors.affiliation: Department of Respiratory Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China.
authors.forename: Junchang
authors.initials: J
authors.lastname: Cui
authors.affiliation: Department of Clinical Pharmacology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Respiratory Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China. Electronic address: liuyouningpla301@163.com.
authors.forename: Youning
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007902:Length of Stay; D008911:Minocycline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016019:Survival Analysis; D000078304:Tigecycline; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline
keywords: Acinetobacter baumannii; Meta-analysis; Multidrug resistance; Tigecycline; Treatment