Use of intravenous tigecycline in patients with severe Clostridium difficile infection: a retrospective observational cohort study.
Clin Microbiol Infect. 2016 Sep 3;
Authors: Szabo BG, Kadar B, Lenart KS, Dezsenyi B, Kunovszki P, Fried K, Kamotsay K, Nikolova R, Prinz G
OBJECTIVES: 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 to standard therapy (oral vancomycin plus intravenous metronidazole) in adults treated for sCDI.
METHODS: 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 to 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.
RESULTS: 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 to 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.
CONCLUSIONS: Favourable outcomes suggest that tigecycline might be considered as a potential candidate for therapeutic usage in cases of sCDI refractory to standard treatment.
PMID: 27599690 [PubMed - as supplied by publisher]