Infection and Drug Resistance (Feb 2023)
Evaluation of Tigecycline Utilization and Trends in Antibacterial Resistance from 2018 to 2021 in a Comprehensive Teaching Hospital in China
Abstract
Hong Zhou,1,* Xiangyu Sun,2,* Shaocheng Lyu,3 Xiaojia Yu,1 Ran Li,4 Huaguang Wang,1 Zhuoling An1 1Pharmacy Department of Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Drug and Equipment Department, Beijing Chaoyang Emergency Medical Rescuing Center, Beijing, People’s Republic of China; 3Department of Hepatobiliary Surgery, Beijing Chao Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Department of Infectious Diseases and Clinical Microbiology, Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huaguang Wang; Zhuoling An, Pharmacy Department of Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China, Email [email protected]; [email protected]: Tigecycline, the first glycylcycline antibiotic, which was widely used for off-label indications because of its broad-spectrum antibacterial activity. This study evaluated the indications for clinical use of tigecycline, clinical and microbiological effectiveness, factors associated with in hospital mortality, and bacterial resistance.Methods: This retrospective study evaluated all inpatients who received tigecycline treatment for > 72 hours between January 2018 and December 2021 in a comprehensive teaching hospital in China. The evaluation included indications, administration regimen, etiology, efficacy and so on. Univariate and multivariate analyses were used to evaluate the risk factors for all-cause mortality.Results: There were 203 patients treated with tigecycline. Tigecycline was commonly prescribed for off-label indications (83.25%, 169/203), and hospital-acquired pneumonia ranked first (79.29%, 134/169). The most common pathogen was Acinetobacter baumannii. Clinical and microbiological success was 57.14% (116/203) and 32.28% (41/127), respectively. Fifty-four patients died and all-cause mortality was 26.60%. Univariate and multivariate analyses showed no significant difference in age, gender, off-label indication, duration of treatment, combination with other drugs, multidrug-resistant or extensively drug-resistant infections and tigecycline application scoring with respect to mortality.Conclusion: Although detection of A. baumannii has decreased in the past 4 years in our hospital, resistance to tigecycline has increased. For clinical application, physicians attach importance to detection of pathogenic microorganisms, but there is still empirical medication without bacterial culture reports. Therefore, an antibiotic stewardship program oriented toward tigecycline should be strengthened to curb bacterial resistance.Keywords: off-label indication, antimicrobial resistance, rationality of medication, clinical prognosis
