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Efficacy and safety of high dose tigecycline in treatment of patients with ventilator-associated pneumonia

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Author:
No author available
Journal Title:
Chinese Journal of Clinical Infectious Diseases
Issue:
5
DOI:
10.3760/cma.j.issn.1674-2397.2016.05.008
Key Word:
肺炎,呼吸机相关性;替加环素;加倍剂量;多重耐药菌;Pneumonia,ventilator-associated;Tigecycline;High dose;Multidrug-resistant bacteria

Abstract: Objective To assess the efficacy and safety of high dose tigecycline (TGC) in treatment of patients with ventilator-associated pneumonia (VAP).Methods The clinical data collected from 71 patients with VAP in emergency intensive care unit of Zhejiang Provincial People’s Hospital from February 201 2 to December 201 5 were analyzed retrospectively.Thirty one patients were treated with TGC 50 mg q1 2h (standard dose group),and 40 patients were treated with TGC 1 00 mg q1 2h (high dose group).t(rank-sum)-test or chi-square test were used to analyze the data including antibiotics use,clinical cure rate,microbiological eradication rate and drug safety.Multivariate logistic regression analysis was performed to determine the factors associated with clinical treatment.Results There were no significant differences in TGC alone and in combination with other antibiotics between two groups (P >0.05 ). Among71 patients,34 were defined as clinical cure and 37 as treatment failure.The clinical cure rate in the high dose group (24 /40,60.0%)was higher than that in the standard dose group (1 0 /31 ,32.3%)(χ2 =5.386,P <0.05 ).Seventy one strains of bacteria were identified,of which carbapenem-resistant&nbsp;Acinetobacterbaumannii (42 isolates ) and Klebsiellapneumoniae (1 7 isolates ) were the main isolated pathogens.Bacterial clearance rate in the high dose group (20 /40,50.0%)was also higher than that in the standard dose group (8 /31 ,25.8%)(χ2 =4.280,P <0.05).Logistic regression analysis demonstrated that the use of high dose tigecycline was independent predictor of clinical cure (OR =0.322,95% CI:0.1 05-0.989),while initial inadequate antimicrobial treatment was predictor of treatment failure (OR =8.207,95% CI:1 .802-37.367 ).There were no statistical differences in blood urea nitrogen,serum creatinine,alanine aminotransferase,total bilirubin,hemoglobin and blood platelet count before and after treatment between two groups (P >0.05).Conclusions High dose TGC can improve the clinical cure rate in treatment of patients with VAP,initial inadequate antimicrobial use would result in the treatment failure. Both high dose and standard dose TGC are safe in administration.

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