综述：替加环素对治疗多重耐药（包括对碳青霉烯类抗生素耐药）的不动杆菌感染的作用

David

Journal of Antimicrobial Chemotherapy 2008 62(1):45-55
Systematic reviews


Tigecycline for the treatment of multidrug-resistant (including carbapenem-resistant) Acinetobacter infections: a review of the scientific evidence
替加环素对治疗多重耐药（包括对碳青霉烯类抗生素耐药）的不动杆菌感染的作用：基于循证医学的综述
Drosos E. Karageorgopoulos1, Theodore Kelesidis1,2, Iosif Kelesidis1,3 and Matthew E. Falagas1,4,5,*
1 Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece 2 Department of Medicine, Caritas St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA 3 Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA 4 Department of Medicine, Henry Dunant Hospital, Athens, Greece 5 Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

Received 7 January 2008; returned 21 February 2008; revised 20 March 2008; accepted 21 March 2008

* Correspondence address. Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece. Tel: +30-694-611-0000; Fax: +30-210-683-9605; E-mail: m.falagas@aibs.gr

Objectives: New antibacterial agents are required for the treatment of infections caused by multidrug-resistant (MDR) Acinetobacter spp. Whether tigecycline constitutes an effective treatment option or not, is not well established. We sought to evaluate the available evidence regarding the microbiological activity and clinical effectiveness of tigecycline for MDR (including the subset of carbapenem-resistant) Acinetobacter spp.

Methods: We searched PubMed for relevant articles and extracted/evaluated the available evidence.

Results: We identified 22 microbiological studies reporting data for 2384 Acinetobacter spp. (1906 Acinetobacter baumannii). Susceptibility of at least 90% of the Acinetobacter isolates to tigecycline (with an MIC breakpoint of susceptibility 2 mg/L) was noted in 9/18 studies reporting data on MDR Acinetobacter and in 7/15 studies reporting specific data on carbapenem-resistant Acinetobacter. In an additional study reporting data for both resistance categories, adequate susceptibility of Acinetobacter spp. was observed by one (broth microdilution) of the methods employed. The effectiveness of tigecycline for MDR Acinetobacter infections was evaluated in eight identified clinical studies, reporting retrospective data regarding 42 severely ill patients, among whom 31 had respiratory tract infection (in 4 cases with secondary bacteraemia) and 4 had bacteraemia. Tigecycline therapy (in combination with other antibiotics in 28 patients) was effective in 32/42 cases. In three cases, resistance to tigecycline developed during treatment.

Conclusions: Tigecycline showed considerable, though not consistent, antimicrobial activity against MDR (including carbapenem-resistant) Acinetobacter spp. However, data to support its clinical use, particularly for ventilator-associated pneumonia or bacteraemia, caused by these pathogens, are still limited.

Keywords: glycylcyclines , imipenem , bloodstream infections , microbial drug resistance , Acinetobacter baumannii