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Communication

Impact of Tigecycline’s MIC in the Outcome of Critically Ill Patients with Carbapenemase-Producing Klebsiella pneumoniae Bacteraemia Treated with Tigecycline Monotherapy—Validation of 2019′s EUCAST Proposed Breakpoint Changes

1
Division of Infectious Diseases, School of Medicine, University of Patras, 265 04 Patras, Greece
2
Department of Microbiology, School of Medicine, University of Patras, 265 04 Patras, Greece
3
Anesthesiology and Critical Care Medicine, School of Medicine, University of Patras, 265 04 Patras, Greece
*
Author to whom correspondence should be addressed.
Present address: Infectious Diseases Service, Lausanne University Hospital, 1011 Lausanne, Switzerland.
Received: 27 October 2020 / Revised: 15 November 2020 / Accepted: 18 November 2020 / Published: 19 November 2020
(This article belongs to the Special Issue Antimicrobial Resistance: The Final Frontier)
Background: Tigecycline is a therapeutic option for carbapenemase-producing Klebsiella pneumoniae (CP-Kp). Our aim was to evaluate the impact of the tigecycline’s minimum inhibitory concentration (MIC) in the outcome of patients with CP-Kp bacteraemia treated with tigecycline monotherapy. Methods: Patients with monomicrobial bacteraemia due to CP-Kp that received appropriate targeted monotherapy or no appropriate treatment were included. Primary outcome was 30-day mortality. MICs of meropenem, tigecycline, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. PCR for blaKPC, blaVIM, blaNDM, and blaOXA genes was applied. Results: Among 302 CP-Kp bacteraemias, 32 isolates (10.6%) showed MICs of tigecycline ≤ 0.5 mg/L, whereas 177 (58.6%) showed MICs that were 0.75–2 mg/L. Colistin and aminoglycoside susceptibility was observed in 43.0% and 23.8% of isolates, respectively. The majority of isolates carried blaKPC (249; 82.5%), followed by blaVIM (26; 8.6%), both blaKPC and blaVIM (16; 5.3%), and blaNDM (11; 3.6%). Fifteen patients with tigecycline MIC ≤ 0.5 mg/L and 55 with MIC 0.75–2 mg/L were treated with tigecycline monotherapy; 30-day mortality was 20.0% and 50.9%, respectively (p = 0.042). Mortality of 150 patients that received other antimicrobials was 24.7%; among 82 patients that received no appropriate treatment, mortality was 39.0%. No difference in 30-day mortality was observed between patients that received tigecycline (MIC ≤ 0.5 mg/L) or other antimicrobials. Conclusion: Tigecycline monotherapy was as efficacious as other antimicrobials in the treatment of bloodstream infections due to CP-Kp isolates with a tigecycline’s MIC ≤ 0.5 mg/L. View Full-Text
Keywords: tigecycline; bloodstream infection; carbapenemase; carbapenem-resistance; ceftazidime/avibactam; colistin; mortality tigecycline; bloodstream infection; carbapenemase; carbapenem-resistance; ceftazidime/avibactam; colistin; mortality
MDPI and ACS Style

Papadimitriou-Olivgeris, M.; Bartzavali, C.; Nikolopoulou, A.; Kolonitsiou, F.; Mplani, V.; Spiliopoulou, I.; Christofidou, M.; Fligou, F.; Marangos, M. Impact of Tigecycline’s MIC in the Outcome of Critically Ill Patients with Carbapenemase-Producing Klebsiella pneumoniae Bacteraemia Treated with Tigecycline Monotherapy—Validation of 2019′s EUCAST Proposed Breakpoint Changes. Antibiotics 2020, 9, 828. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9110828

AMA Style

Papadimitriou-Olivgeris M, Bartzavali C, Nikolopoulou A, Kolonitsiou F, Mplani V, Spiliopoulou I, Christofidou M, Fligou F, Marangos M. Impact of Tigecycline’s MIC in the Outcome of Critically Ill Patients with Carbapenemase-Producing Klebsiella pneumoniae Bacteraemia Treated with Tigecycline Monotherapy—Validation of 2019′s EUCAST Proposed Breakpoint Changes. Antibiotics. 2020; 9(11):828. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9110828

Chicago/Turabian Style

Papadimitriou-Olivgeris, Matthaios, Christina Bartzavali, Alexandra Nikolopoulou, Fevronia Kolonitsiou, Virginia Mplani, Iris Spiliopoulou, Myrto Christofidou, Fotini Fligou, and Markos Marangos. 2020. "Impact of Tigecycline’s MIC in the Outcome of Critically Ill Patients with Carbapenemase-Producing Klebsiella pneumoniae Bacteraemia Treated with Tigecycline Monotherapy—Validation of 2019′s EUCAST Proposed Breakpoint Changes" Antibiotics 9, no. 11: 828. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9110828

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