| Background:Tigecycline is the first glycylcycline antimicrobial drug applied in clinical practice. It is featured by a broad antibacterial spectrum and less susceptible to drug resistance. In the current clinical work in China, tigecycline is usually regarded as the last line of defense in the treatment of MDR bacteria-induced severe infection patients. With the increasing application of tigecycline, the research on its adverse reactions becomes more and more important. According to the FDA adverse event reporting system database, the common adverse reactions of tigecycline include gastrointestinal symptoms like nausea and vomiting, pancreatitis, liver failure, hypoglycemia, etc. However, its effect on the coagulation function remains unclear. In the recent few years, the cases, where tigecycline results in fibrinogen reduction, have been reported abroad once in a while. Moreover, in the clinical treatment of severe infection patients using tigecycline, fibrinogen reduction has been repeatedly observed. Therefore, it is necessary to conduct a systematic retrospective analysis regarding the effect of tigecycline on patient coagulation function during treatment.Objective:To characterize the effect on coagulation function of tigecycline treatment in severe infection patients, and to provide reference for clinical rational use of tigecycline.Methods:Retrospective study of the patients admitted to Shandong University Affiliated Qilu Hospital from April 2012 to December 2014, who received tigecycline treatment more than 72h. Patients were recorded fibrinogen (FIB), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) before tigecycline treatment, during treatment, and after treatment, in order to assess the effect of coagulation function. Record the CRP, body temperature WBC and NEU%, in order to assess the infection status during treatment. Comparing the ALT, TBIL, Cr before and after tigecycline treatment, in order to assess the influence to hepatic and renal function. Record the blood transfusions and bleeding events. Using SPSS 22.0 software for statistical analysis, and evaluating the impact of tigecycline on coagulation function of patients.Results:151 patients met the inclusion criteria. The FIB average value of all patients decreased with the passage of drug administration time. Compared with the beginning, on the each group of drug administration time, the FIB average was statistically different(P<0.05). After drug withdrawal, the FIB average was increased with the passage of time. On the group of 5th to 7th days and group of more than 7 days after cessation of treatment, the FIB average was statistically different from the treatment time. The PT, APTT, TT were increased with the passage of drug administration time, and decreased with the passage time of drug withdrawal. But PLT didn’t appear significant difference between before and after treatment. During tigecycline treatment, CRP and body temperature was decreased significantly, but WBC, NEU% appeared less change. The ALT, TBIL, Cr of patients didn’t appear significant different before and after tigecycline treatment. The blood transfusions were higher than the average of common patients in ICU.Discussion:1. Tigecycline will influence coagulation, which performance of fibrinogen decreased and PT, APTT, TT prolonged within a short time, but hardly any influence to PLT. What’s more, coagulation functions could recover gradually after tigecycline treatment.2. The blood transfusion rate and the incidence rate of bleeding events for the patients who received tigecycline treatment were higher than normal ICU patients. So during the tigecycline treatment, coagulation changes should be monitored.3. During the tigecycline treatment, patients’infection status is improving, and there is no significant different for hepatic and renal function indicators before and after treatment, which shows that FIB decrease may be not relevant to infection aggravating or liver or kidney function lesions. |
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