Bálint Gergely Szabó1,2,3, Lilla Duma4, Katalin Szidónia Lénárt1,2, Béla Kádár1,2,5, Balázs Dezsényi1, Eszter Ostorházi5, János Szlávik1
1: South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Department of Infectious Diseases, Budapest, Hungary
2: Semmelweis University, 3rd Department of Internal Medicine, Departmental Group of Infectology, Infectious Disease Specialist Training, Budapest, Hungary
3: Semmelweis University, Károly Rácz School of PhD Studies, Doctoral School of Clinical Medicine, Budapest, Hungary
4: Semmelweis University, Faculty of Medicine, Medical Doctor Training, Budapest, Hungary
5: Semmelweis University, Institute of Medical Microbiology, Budapest, Hungary
Introduction, aims: Severe Clostridium difficile infection (sCDI) poses significant morbidity, mortality worldwide. Tigecycline has activity against C.difficile, the current ESCMID guideline recommends it as alternative for sCDI. Some studies reported on therapeutic failures. Our aim was to analyse characteristics of treatment failure with intravenous tigecycline monotherapy among adults with sCDI.
Methods: A single-center cohort study of patients receiving tigecycline for ≥48 hours at our centre between 2014–2018 was executed. Data were collected from medical charts, diagnosis and severity were determined per ESCMID guideline. Primary outcome was treatment failure, secondary outcomes were in-hospital mortality and relapse, colectomy and complication (sepsis, ileus, toxic megacolon) rates. Mann–Whitney and Fisher's tests were used, independent predictors of failure were identified using logistic regression.
Results: 110 patients (median age 75.0±14.4 years, 50.9% men) were included, 69/110 (62.7%) had treatment success, 41/110 (37.3%) had failure. Median starting day from admission (8.0±7.0 vs. 3.5±5.3, p=0.01) and therapy duration differed (10.0±2.0 vs. 8.5±5.0, p=0.01). Failure associated with chronic heart (72.5 vs. 92.7%, p=0.01) and pulmonary diseases (18.8 vs. 41.5%, p=0.01), shorter symptom durations (12.0±14.0 vs. 7.0±9.8 days, p=0.01), higher ICU admittances (10.1 vs. 34.1%, p=0.01). In addition, total parenteral nutrition (20.3 vs. 46.3%, p=0.01) and vasopressor support (15.9 vs. 36.6%, p=0.02) were commonly needed. All-cause (7.2 vs. 75.6%, p<0.01) and CDI-specific mortality (1.5 vs. 34.1%, p=0.37) were lower among successful cases, relapse (4.3 vs. 4.9%, p=1.0) and sepsis (13.0 vs. 26.8%, p=0.07) rates were similar. Among failure, ileus (7.2 vs. 26.8%, p=0.01), toxic megacolon (1.4 vs. 24.4%, p=0.01) were prevalent, colectomy (0 vs. 12.2%, p<0.01) was frequently performed. Chronic pulmonary disease, duration of therapy, ileus, total parenteral nutrition were independent predictors of failure in logistic regression.
Conclusion: Our data suggests that sCDI cases with higher risk for tigecycline monotherapy failure might be identifiable by some contributing factors.
Doctoral School: Clinical Medicine (2.)
Program: Dermatology and Venereology (16.)
Supervisor: Eszter Ostorhazi, M.D. PhD
E-mail address: firstname.lastname@example.org
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