| Objective:This study was aimed to observe the efficacy of tigecycline in critically ill patients with serious infections and investigated the legitimately therapeutic programs to provide reference for clinical practice in curing infections with tigecycline. Method:This retrospective study was carded on critically ill patients from the Respiratory intensive care unit(RICU) between December 2012 and October 2014.If the pathogenic examination indicated multi-drug re- sistant bacteria( except pseudomonas aeruginosa),the patients would be administrated with tigecycline.The efficacy of tigecycline would be comprehensively appraised from both clinical medicine and microbiology. When data entried into the computerized database,statistical analyses were performed with the software of SPSS 20.0. Results:28 subjects were enrolled in our study,including 15 men based on the selection criteria.All patients received tigecycline as combination therapy. Tigecycline is administered as a standard treatment regimen,the first dose of 100 mg,maintenance dose of 50 mg,1 times / 12 h,and the average delivery time was 10.4±4.1 days.All the patients’ temperature was significantly decreased.Compared with the administration of the first day respectively,the patients’ temperature administered for the third day, the fifth day, the seventh day and the tenth day was statistically significant difference(all P<0.05). The comparisons of levels of WBC,N%(the percentage of neutrophils),CRP and Pa O2 /Fi O2 were of statistically significant difference with the previous treatments( all P<0.05). The clinical efficiency rates were 53.6%in total of 28 patients.The 28 cases were divided into different subgroups.The clinical efficiency rate of subjects with APACHE II score over 20 was obviously lower than the rest ones(25.0%VS75.0%,P=0.02)and only the difference was statistically significant in all subgroups. The clinical efficiency rate of groups of etiology results return in 3 days, was higher than groups of etiology results return more than 3 days,but the difference was not statistically significant(P = 0.14). The clinical efficiency rate of patients with treatment time over 7days was higher than the rest ones(66.7% VS 30.0%,P=0.11). 79 resistant bacteria were isolated and the total clearance rate was 42.9% of pathogens.Of the microbiologically evaluable cases,MDRAB(Multidrug-resistant acinetobacter baumannii) predominated(42/79,53.2%) and the rate of pathogen clearance was 45.5%. Most pathogens maintained high sensitivity for tigecycline.The leading adverse reaction for tigecycline was gastrointestinal symptom(61.5%). The rate of 30 days mortality was 42.9%% of all patients with tigecycline. Conclusions:1. Pathogens maintained high sensitive to tigecycline and it was effective to use tigecycline for infections caused by Gram-positive and Gram-negative multi-drug resistant pathogens that were difficult for clinical treatment.2. Tigecycline may be one of the early appropriately drug selections for MDRAB infections in critically ill patients with quite limited therapy selections and high mortality rate.3.Tigecycline was safe and effective for multi-drug resistant infections in critically ill patients. Appropriate treatment occasion,sufficient dosage, full course of treatment and combination therapy were the key factors for clinical success. |
PDF Full Text Request