Severe infections: efficacy and safety of high-dose tigecycline

Takeaway

• This meta-analysis suggests that high-dose tigecycline (HDT) treatment demonstrated better clinical outcomes in the treatment of severe infections compared with standard-dose tigecycline and other non-tigecycline-containing regimens.

Why this matters

• HDT is recommended to patients with multidrug-resistant bacterial infections if a tigecycline-containing regimen is the clinical choice for severe infections.

Study design

• 10 studies (n=593) met eligibility criteria after a search across electronic databases.
• Primary outcome: all-cause mortality.
• Secondary outcomes: clinical cure rate, microbiological eradication rate, and adverse events.
• Funding: Conch Hospital.

Key results

• HDT vs placebo group had:
  • lower all-cause mortality (OR, 0.44; 95% CI, 0.30-0.66; P<.0001);
  • higher clinical cure (OR, 3.43; 95% CI, 2.09-5.63; P<.00001) and microbiological eradication rate (OR, 2.25; 95% CI, 1.44-3.50; P=.0003).
• In subgroup analysis, HDT reduced all-cause mortality associated with:
  • hospital-acquired pneumonia (OR, 0.39; 95% CI, 0.22-0.70; P=.002);
  • blood stream infections (OR, 0.19; 95% CI, 0.06-0.58; P=.004); and
  • mixed infections (OR, 0.20; 95% CI, 0.07-0.59; P=.003).
• No significant difference was observed in complicated intra-abdominal infections between HDT and placebo group (OR, 2.04; 95% CI, 0.80-5.23; P=.14).
• The incidence of adverse events did not differ between the HDT and placebo group.
• In carbapenem-resistant pathogens, microbiological eradication rates did not differ between HDT and control group (OR, 1.07; 95% CI, 0.44-2.60; P=.87) but a reduction in mortality was observed in HDT group (OR, 0.20; 95% CI, 0.09-0.45; P=.0001).

Limitations

• Most of the studies were observational.
• Small sample size.