A Clinical Observation Of Tigecycline In The Treatment Of Hematological Agranulocytic Patients With Fever

Objective: To observe the clinical efficacy and safety of therapy of standard and high dose of tigecycline in treating the patient with hematologic malignancies of agranulocytosis and fever.Methods: The clinical data of 71 cases of agranulocytosis and fever were treated were retrospectively reviewed.Among them,56 patients received treatment with standard dose of tigecycline,the other 15 patients received treatment with high dose of tigecycline.The initial and maintenance dose of tigecycline was 100 mg and 50 mg once every 12 hours,separately,in the standard group.As for the high-dose group,the initial and maintenance dose of tigecycline was 100 mg and 100 mg once every 12 hours,separately.Results: Medication duration of tigecycline was 6.5 days for 71 cases.The results show that,body peak temperature decreased or dropped to normal,improvement of clinical symptoms and were shown in 37 cases.In contrary,body temperature did not fall or even higher in 31 cases.That was the number of effect and inefficacy after treatment were 37 and 34 cases respectively,the total effective rate was 52.11%.What's more,the effective rate of the control group and the observation group were separately 51.79%and 53.33%,and no statistically significant difference between the test and control group(P=0.915).From the 71 patients with malignant hemopathy,67 bacterial strains were isolated.Among them,gram-negative bacteria constituted 82.09%(55 strains),48 strains were sensitive to tigecycline,and gram-positive bacteria 14.93%(10 strains),10 strains were sensitive to tigecycline;fungi accounted for 2.99%(2strains).The 25 strains of multi-resistant pathogens were detected from the 71 patients,among them,18 strains which consist of 9 strains of Klebsiella pneumoniae,6 strains of Escherichia coli and 3 strains of Acinetobacter baumannii were susceptible to tigecycline,4 strains which include 3 strains of Klebsiella pneumoniae and 1 strain Flavobacterium meningosepticum were medium sensitive to tigecycline,but how,in the meantime,3strains of Klebsiella pneumoniae showed resistance to tigecycline.The 25 bacterial strains were detected from 27 patients who can be evaluated for bacteriology,with a63.16% bacterial eradication.It is note that tigecyclines were used in conjunction with other antibiotics for 71 patients,with 35.3% of cefoperazone sodium and sulbactam sodium,19.2% of carbapenems,19.2% of piperacillin tazobactam,10.1% of quinolones,9.1% of vancomycin,5.1% of amikacin.The diverse reactions involved a total of 4cases,included 2 patients with nausea and vomiting and 1 patient with diarrhea in the standard dose group,1 patients with nausea and vomiting in the high dose group were observed during the drug.But it is worth noting that the diverse reactions were corrected after symptomatic treatment for both groups.Conclusion: The research result demonstrates that patients who suffered from hematologic malignancies of agranulocytosis were effectively controlled by treating with standard and high dose of tigecycline in a low rate of adverse reactions and high safety way.