7脓毒血症和脓毒血性休克的抗生素治疗(重庆会议).ppt

* * Slide 10 * * As with the polymyxins, clinical experience with tigecycline for MDR gram-negative organisms remains limited mostly to case reports and case series. However, Vasilev et al conducted an open-label, noncomparative, multicenter study of tigecycline for the treatment of patients with serious infections caused by MDR gram-negative organisms. After a loading dose of 100 mg, tigecycline was dosed at 50 mg every 12 hours for 7-28 days. A patient was considered to have an MDR organism if any of the following were true: 1) it was a documented ESBL producer; 2) the patient had failed clinically, the organism was resistant to, or the patient could not receive (due to allergy or intolerance) at least 1 agent from ≥3 antibiotic classes: penicillins, extended-spectrum cephalosporins, carbapenems, fluoroquinolones, and aminoglycosides; or 3) any A baumannii infection. The microbiologically evaluable (ME) population consisted of 36 patients who had at least 1 isolate that met the definition of resistance and was susceptible to tigecycline and who completed the test-of-cure assessment. The modified intent-to-treat (m-mITT) population included 75 patients who received at least 1 dose of tigecycline. More than half of the patients had complicated skin and skin structure infections, while HAP and complicated intra-abdominal infection were also common. One patient in the ME population and 6 patients in the m-mITT population had bacteremia, often catheter-associated. Clinical cure rates for all organisms and for the most common pathogens are shown on this slide. The microbiological eradication rates were 66.7% and 49.3% in the ME and m-mITT populations, respectively. Among the patients with bacteremia, clinical cure rates were 0% and 16.7% in the ME and m-mITT populations, respectively. Since patients were not identified for study inclusion until culture results were known, the appropriateness of initial antibiotic therapy was not controlled in this study. However, tig