Acinetobacter baumannii bloodstream infection while receiving tigecycline:: a cautionary report

被引:207
作者
Peleg, Anton Y.
Potoski, Brian A.
Rea, Rhonda
Adams, Jennifer
Sethi, Jigme
Capitano, Blair
Husain, Shahid
Kwak, Eun J.
Bhat, Sunil V.
Paterson, David L. [1 ]
机构
[1] Univ Pittsburgh, Med Ctr, Div Infect Dis, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Sch Pharm, Dept Pharm & Therapeut, Pittsburgh, PA 15213 USA
[3] Univ Pittsburgh, Med Ctr, Div Pulm Allergy & Crit Care Med, Pittsburgh, PA 15213 USA
关键词
A; baumannii; glycylcycline; GAR-936; antibiotic resistance;
D O I
10.1093/jac/dkl441
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives: Tigecycline has shown in vitro activity against Acinetobacter baumannii. Yet, published clinical experience with tigecycline use outside clinical trials is lacking. We describe, for the first time, bloodstream infection caused by tigecycline-non-susceptible A. baumannii occurring in patients receiving tigecycline for other indications. The possible mechanisms of resistance and pharmacokinetic limitations of the drug are addressed. Methods: The clinical records of involved patients were systematically reviewed. Tigecycline susceptibility testing was initially performed using the Etest method and confirmed by agar dilution. Involved isolates underwent PFGE and exposure to phenyl-arginine-beta-naphthylamide (PA beta N), an efflux pump inhibitor. Results: Two patients developed A. baumannii bloodstream infection while receiving tigecycline. Tigecycline was administered for other indications for 9 and 16 days, respectively, before the onset of A. baumannii infection. Patient 1 died of overwhelming A. baumannii infection and Patient 2 recovered after a change in antibiotic therapy. The MICs of tigecycline were 4 and 16 mg/L, respectively. Both isolates had a multidrug-resistant phenotype and were genotypically unrelated. After exposure to PA beta N, the MICs reduced to 1 and 4 mg/L, respectively. Conclusions: To our knowledge, this is the first clinical description of bloodstream infection caused by tigecycline-non-susceptible A. baumannii. Such resistance appears to be at least partly attributable to an efflux pump mechanism. Given the reported low serum tigecycline levels, we urge caution when using this drug for treatment of A. baumannii bloodstream infection.
引用
收藏
页码:128 / 131
页数:4
相关论文
共 12 条
[1]   The efficacy and safety of tigecycline for the treatment of complicated intra-abdominal infections: Analysis of pooled clinical trial data [J].
Babinchak, T ;
Ellis-Grosse, E ;
Dartois, N ;
Rose, GM ;
Loh, E .
CLINICAL INFECTIOUS DISEASES, 2005, 41 :S354-S367
[2]   Efflux-mediated resistance to tigecycline (GAR-936) in Pseudomonas aeruginosa PAO1 [J].
Dean, CR ;
Visalli, MA ;
Projan, SJ ;
Sum, PE ;
Bradford, PA .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2003, 47 (03) :972-978
[3]   The efficacy and safety of tigecycline in the treatment of skin and skin-structure infections: Results of 2 double-blind phase 3 comparison studies with vancomycin-aztreonam [J].
Ellis-Grosse, EJ ;
Babinchak, T ;
Dartois, N ;
Rose, G ;
Loh, E .
CLINICAL INFECTIOUS DISEASES, 2005, 41 :S341-S353
[4]   Antibiotic resistance among clinical isolates of Acinetobacter in the UK, and in vitro evaluation of tigecycline (GAR-936) [J].
Henwood, CJ ;
Gatward, T ;
Warner, M ;
James, D ;
Stockdale, MW ;
Spence, RP ;
Towner, KJ ;
Livermore, DM ;
Woodford, N .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2002, 49 (03) :479-487
[5]   Tigecycline: what is it, and where should it be used? [J].
Livermore, DM .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2005, 56 (04) :611-614
[6]   Resistance-nodulation-cell division-type efflux pump involved in aminoglycoside resistance in Acinetobacter baumannii strain BM4454 [J].
Magnet, S ;
Courvalin, P ;
Lambert, T .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2001, 45 (12) :3375-3380
[7]  
OWEN J, 2004, 44 INT C ANT AG CHEM
[8]   Molecular epidemiology and mechanisms of carbapenem resistance in Acinetobacter baumannii endemic in New York City [J].
Quale, J ;
Bratu, S ;
Landman, D ;
Heddurshetti, R .
CLINICAL INFECTIOUS DISEASES, 2003, 37 (02) :214-220
[9]   Influence of transcriptional activator RamA on expression of multidrug efflux pump AcrAB and tigecycline susceptibility in Klebsiella pneumoniae [J].
Ruzin, A ;
Visalli, MA ;
Keeney, D ;
Bradford, PA .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2005, 49 (03) :1017-1022
[10]   INTERPRETING CHROMOSOMAL DNA RESTRICTION PATTERNS PRODUCED BY PULSED-FIELD GEL-ELECTROPHORESIS - CRITERIA FOR BACTERIAL STRAIN TYPING [J].
TENOVER, FC ;
ARBEIT, RD ;
GOERING, RV ;
MICKELSEN, PA ;
MURRAY, BE ;
PERSING, DH ;
SWAMINATHAN, B .
JOURNAL OF CLINICAL MICROBIOLOGY, 1995, 33 (09) :2233-2239