title: Effectiveness and Safety of Tigecycline Compared with Other Broad-Spectrum Antimicrobials in Abdominal Solid Organ Transplant Recipients with Polymicrobial Intraabdominal Infections.
abstract: Because patients with abdominal solid organ transplants (SOTs) are at increased risk of polymicrobial intraabdominal infections (IAIs) following transplantation, the objective of this study was to compare the effectiveness and adverse event profile of tigecycline with those of other broad-spectrum therapies for polymicrobial IAIs in this population.
  
  
  
  Retrospective cohort study.
  
  
  
  Large academic medical center with multiple outpatient clinics.
  
  
  
  A total of 81 adult SOT recipients were included who were treated for confirmed or suspected polymicrobial IAIs from 2007-2012. Of these patients, 27 received tigecycline and 54 received comparator therapy with a broad-spectrum β-lactam (e.g., piperacillin-tazobactam, cefepime, or meropenem) with or without glycopeptide or lipopeptide gram-positive therapy (vancomycin or daptomycin) (comparator group). Patients in the comparator group were matched to tigecycline-treated patients based on transplant type (kidney, combined kidney-pancreas, combined kidney-liver, or solitary pancreas) in a 1:2 ratio (tigecycline-to-other broad-spectrum antibiotics).
  
  
  
  Data on patient demographics, comorbidities, and clinical variables were collected and compared by using bivariate analyses. Clinical outcomes-clinical cure, improvement or failure, and disease recurrence-as well as death within 1 year were analyzed by bivariate analyses and logistic regression. Clinical cure was lower in the tigecycline group versus the comparator group (40.7% vs 72.2%, p=0.008), but cure combined with improvement was similar between the two groups (85.2% vs 88.9%, p=0.724). Multiple logistic regression analysis showed that treatment with comparator antibiotics increased the odds of cure (odds ratio [OR] 1.37, 95% confidence interval [CI] 0.15-12.27) and reduced the odds of treatment failure (OR 0.59, 95% CI 0.07-4.55) and death within 1 year (OR 0.79, 95% CI 0.22-2.86); however, patients receiving comparator antibiotics were more likely to have disease recurrence (OR 1.45, 95% CI 0.33-6.36). Patients receiving tigecycline experienced a higher rate of adverse events than those receiving comparator antibiotics (29.6% vs 9.3%, p=0.026).
  
  
  
  Patients receiving tigecycline were less likely to achieve optimal clinical outcomes and had more adverse events. Alternative regimens should be selected over tigecycline for the treatment of polymicrobial IAIs in abdominal SOT recipients until additional studies are completed to examine its role in this population.
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.|School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Tyler
authors.initials: T
authors.lastname: Liebenstein
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.|School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Lucas T
authors.initials: LT
authors.lastname: Schulz
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.|School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Chris
authors.initials: C
authors.lastname: Viesselmann
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.|School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Emma
authors.initials: E
authors.lastname: Bingen
authors.affiliation: Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Jackson
authors.initials: J
authors.lastname: Musuuza
authors.affiliation: Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.|School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Warren E
authors.initials: WE
authors.lastname: Rose
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000188:drug therapy* / Q000382:microbiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016377:Organ Transplantation; D012008:Recurrence; D012189:Retrospective Studies; D000078304:Tigecycline; D066027:Transplant Recipients
chemical_list: D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline
keywords: broad-spectrum therapy; glycylcycline; outcomes; polymicrobial infections; transplant