Use of intravenous tigecycline in patients with severe Clostridium difficile infection: a retrospective observational cohort study.
There are only a limited number of antimicrobials for treating severe Clostridium difficile infection (sCDI). Tigecycline shows significant in vitro effect against C. difficile and is approved for management of complicated intra-abdominal infections. Our aim was to analyse the efficacy of tigecycline compared with standard therapy (oral vancomycin plus intravenous metronidazole) in adults treated for sCDI. A retrospective cohort study of such patients hospitalized at our department from January 2014 to December 2015 was performed. Patients receiving tigecycline monotherapy were compared with patients treated with standard therapy alone. Diagnosis and severity of CDI were determined according to guidelines of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Primary outcome was clinical recovery, secondary outcomes were in-hospital and 90-day all-cause mortality and relapse, colectomy, and complication rates. Of the 359 patients hospitalized for sCDI, 90 (25.0%) were included, 45 in each group. Patients treated with tigecycline had significantly better outcomes of clinical cure (34/45, 75.6% vs. 24/45, 53.3%; p 0.02), less complicated disease course (13/45, 28.9% vs. 24/45, 53.3%; p 0.02), and less CDI sepsis (7/45, 15.6% vs. 18/45, 40.0%; p 0.009) compared with patients receiving standard therapy. Tigecycline usage was not associated with adverse drug reactions or need for colectomy. Rates of ileus, toxic megacolon, mortality, and relapse were similar between the two groups. Favourable outcomes suggest that tigecycline might be considered as a potential candidate for therapeutic use in cases of sCDI refractory to standard treatment.
1st Department of Infectology, Joined Saint Stephan and Saint Ladislaus Hospital-Clinic, Budapest, Hungary; Departmental Group of Infectology, 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary. Electronic address: szabo.balint.gergely@freemail.hu.
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Gergely Szabo
1st Department of Infectology, Joined Saint Stephan and Saint Ladislaus Hospital-Clinic, Budapest, Hungary; Departmental Group of Infectology, 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
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Kadar
1st Department of Infectology, Joined Saint Stephan and Saint Ladislaus Hospital-Clinic, Budapest, Hungary; Departmental Group of Infectology, 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
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Szidonia Lenart
1st Department of Infectology, Joined Saint Stephan and Saint Ladislaus Hospital-Clinic, Budapest, Hungary; Departmental Group of Infectology, 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
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Dezsenyi
Budapest University of Technology and Economics, Budapest, Hungary.
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Kunovszki
1st Department of Infectology, Joined Saint Stephan and Saint Ladislaus Hospital-Clinic, Budapest, Hungary.
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Fried
Core Microbiology Laboratory, Joined Saint Stephan and Saint Ladislaus Hospital-Clinic, Budapest, Hungary.
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Kamotsay
Core Microbiology Laboratory, Joined Saint Stephan and Saint Ladislaus Hospital-Clinic, Budapest, Hungary.
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Nikolova
1st Department of Infectology, Joined Saint Stephan and Saint Ladislaus Hospital-Clinic, Budapest, Hungary.
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Prinz
D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects*; D003082:Colectomy; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000188:drug therapy; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy; D000078304:Tigecycline; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin; D000078304:Tigecycline; D008911:Minocycline
Clostridium difficile; Colitis; diarrhoea; nosocomial infection; tigecycline