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Drug-induced acute pancreatitis (AP) associated with tigecycline (TGC) is considered a rare complication (incidence between 1, and 1%). In this paper, we report five cases of AP occurring after the administration of TGC in septic patients hospitalized in intensive burn care in Tunisia over 9 years. The diagnosis of AP was based on clinical and/or biological signs. Among 303 cases treated with TGC, AP occurred with an incidence of 1.65%. The mean age was 28±6 years. Only one patient had a history of chronic alcoholism. The prescribed dose was 200 mg as a loading dose, followed by 100 mg twice a day. The time to onset of symptoms after initiation of TGC was 5.4 days [2-7]. PA was suspected due to abdominal pain associated with nausea and vomiting (n=2), occlusive syndrome (n=1) and fortuitously increased pancreatic enzymes in 2 patients under mechanical ventilation. The mean lipase level at diagnosis was 447 IU ± 135 IU (4.5 to 10 times the normal). All the aetiologies of AP were ruled out, including gallstones, hypercalcemia, hypertriglyceridemia, trauma and infections. The mean time to symptom resolution after stopping TGC was 4±2 days [5-7] and to the normalization of pancreatic enzymes it was 9 days [2-20 days]. In conclusion, clinical and biological monitoring was necessary in patients treated with TGC in order to avoid severe forms, especially in at-risk patients. [ABSTRACT FROM AUTHOR]

Ventricular infection due to XDR Acinetobacter baumanii (A. baumanii) is the most severe complication after neurosurgery which associated with high morbidity and mortality. Managing A. baumanii ventriculitis/shunt infection and multiple brain abscesses is challenging since its nature that tends to be pandrug resistant to all antibiotics used. Thus, we present the first such case with problems in administration based on the available data.

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Drug-induced acute pancreatitis (AP) associated with tigecycline (TGC) is considered a rare complication (incidence between 1‰ and 1%). In this paper, we report five cases of AP occurring after the administration of TGC in septic patients hospitalized in intensive burn care in Tunisia over 9 years. The diagnosis of AP was based on clinical and/or biological signs. Among 303 cases treated with TGC, AP occurred with an incidence of 1.65%. The mean age was 28±6 years. Only one patient had a history of chronic alcoholism. The prescribed dose was 200 mg as a loading dose, followed by 100 mg twice a day. The time to onset of symptoms after initiation of TGC was 5.4 days [2-7]. PA was suspected due to abdominal pain associated with nausea and vomiting (n=2), occlusive syndrome (n=1) and fortuitously increased pancreatic enzymes in 2 patients under mechanical ventilation. The mean lipase level at diagnosis was 447 IU ± 135 IU (4.5 to 10 times the normal). All the aetiologies of AP were ruled out, including gallstones, hypercalcemia, hypertriglyceridemia, trauma and infections. The mean time to symptom resolution after stopping TGC was 4±2 days [5-7] and to the normalization of pancreatic enzymes it was 9 days [2-20 days]. In conclusion, clinical and biological monitoring was necessary in patients treated with TGC in order to avoid severe forms, especially in at-risk patients., (© 2023 Euro-Mediterranean Council for Burns and Fire Disasters.)

Résumé: La tigécycline (TGC) est une nouvelle glycylcycline à spectre large incluant des bactéries multi-résistantes. Notre laboratoire teste en routine l’activité in vitro de la TGC vis-à-vis d’isolats cliniquement significatifs d’entérobactéries résistantes aux céphalosporines de troisième génération (EC3R), d’Acinetobacter baumannii et des Bacteroides du groupe fragilis (BGFR). L’objectif de cette étude est de rapporter les résultats de l’activité in vitro de la TGC vis-à-vis de ces bactéries, isolées au CHU de Montpellier entre 2008 et 2011. Dans cette période d’étude, 1070 isolats d’EC3R dont 541 souches productrices de bêta-lactamase à spectre élargi (BLSE), 47 isolats d’A. baumannii dont 40 multi-résistants et 645 isolats de BGFR ont été testés. Les concentrations minimales inhibitrices (CMI) de la TGC ont été déterminées par la méthode E-test. La majorité (86,2 %) des EC3R testées sont considérées comme sensibles à la TGC (CMI≤1mg/L). Concernant A. Baumannii et BGFR, respectivement 47 % et 84,2 % des souches présentent une CMI inférieure ou égale à 2mg/L. Notre étude confirme l’activité de la TGC sur les EC3R, en particulier Escherichia coli producteur de BLSE. Pour les BGFR, l’impact des CMI supérieures à 2mg/L reste à documenter. Souvent prescrite dans des situations d’impasse thérapeutique, l’utilisation de la TGC nécessiterait la clarification du seuil de sensibilité pour certaines espèces (A. baumannii, BGFR) et une meilleure connaissance de la corrélation entre activité in vitro et in vivo. [ABSTRACT FROM AUTHOR]

Abstract: Tigecycline (TGC), an antibiotic belonging to glycylcyclines, is active against Gram-positive bacteria, including multi-resistant bacteria, and most of the Gram-negative bacteria, including extended spectrum β-lactamase-producers (ESBL) and Acinetobacter sp. TGC is not active on Pseudomonas aeruginosa. The microbiological laboratory from the university hospital of Angers participates in the Tigecycline Evaluation and Surveillance Trial (TEST) since 2006. The objective of this study is to evaluate the effectiveness of TGC and of various comparators against nosocomial and community-acquired pathogens. We also evaluated the effectiveness of TGC on a panel of strains isolated between 2006 and 2009 in the university hospital of Angers. Minimum inhibitory concentrations (MIC) were determined using the microdilution method. A total of 760 clinical strains were tested. TGC had a very good activity against Gram-positive bacteria, with 100 % of susceptibility for all the strains tested, irrespective of their resistance profile. Concerning Gram-negative bacteria, TGC was active against 93 % of Enterobacteriaceae, with a MIC 90 not exceeding 2mg/L. Whole of the 20 strains ESBL-producers tested were susceptible to TGC. Acinetobacter sp. were also inhibited at low concentrations of TGC, with a MIC 90 of 1mg/L. These results suggest that TGC can be a useful therapeutic alternative, especially for infections involving multirésistant bacteria. [Copyright &y& Elsevier]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objectives: To report our experience of tigecycline use in a medical and surgical intensive care unit. To describe its prescription, microbiology findings, tolerance and efficacy. Study design: Prospective, observational, single center study. Patients and methods: All consecutive patients treated with tigecycline were included. Demography, indication of treatment, bacteriology before, during and in the month after treatment and ICU mortality were collected. The main endpoints were clinical and microbiological efficacy and tolerance. Results: Twenty-four patients were included. In half of the cases, tigecycline was prescribed in monotherapy for a complicated intra-abdominal infection. Overall tolerance of tigecycline was good. Clinical and microbiological cure was obtained in six cases, not obtained in nine, indeterminate in six cases and not evaluable in the three cases of prophylaxis. During the treatment, four bacteria commonly sensitives were shown to be resistant to tigecycline. Conclusion: Our pilot study on 24 patients suggests that tigecycline is well tolerated in critically ill patients. Clinical cure in severe infections was compromised in nine patients essentially because of resistant pathogens suggesting its prescription on antibiogram. However, the impact of association or the increasing doses in severe critically ill patients should be evaluated. [Copyright &y& Elsevier]

Abstract: Tigecycline (TGC), a semisynthetic glycylcycline, has a documented activity on Gram+ and Gram− pathogens including oxacillin-resistant (MRSA) and an extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Tigecycline Evaluation and Surveillance Trial (TEST) is an international surveillance study designed to assess the in vitro activity of TGC and 11 comparators against a range of important clinical pathogens from both the community and the hospital. The aim of this study was to assess efficacy of TGC, using this database, against pathogens implicated in community or hospital pneumonia and sinusitis. A total of 4163 isolates were consecutively collected in 21 European countries during three years (2004–2007). In all center, minimum inhibitory concentration (MIC) were determinated with the same Microscan panel (Dade-Behring). Tigecycline exhibited a good activity against respiratory pathogens, with the exception of Pseudomonas aeruginosa. Hundred percent of cocci Gram+ (Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus sp.) and 100% of Haemophilus sp. are inhibited with 0,5mg/L, without effect of an associated β-lactam resistance mechanism. TGC is active in vitro on 89% of Enterobacteriaceae, with MIC 90 less or equal to 2mg/L. Eighty-nine percent of Enterobacter sp. and 77% of Serratia sp. are susceptible with range of MIC 90 from 2 to 4mg/L. These interesting results obtained in vitro are to be strengthened by clinical studies. [Copyright &y& Elsevier]

Abstract: Tigecycline Evaluation and Surveillance Trial (TEST) is an international surveillance study designed to assess the in vitro activity of tigecycline and 11 comparators against a range of important clinical pathogens from both the community and the hospital. The updated data obtained from the TEST program are integrated in a database server and available with a web application. The website has been designed to disseminate data collected from the international TEST program to the medical community and has been developed to be user-friendly. The use of this program-specific website can be made in a timely manner to extract antimicrobial resistance data of major microorganisms based on chosen selection criteria. This article describes how to use this web-based program for different analyse-types and the multiple options to display search results. Data can be presented in a table or as a graph or diagram, according to the source of the isolate, type of unit, resistance pattern of the pathogen. The website also allows the user to compare the data of antimicrobial testing at a national or regional level. It provides within a few minutes details on the activity of tigecycline and 11 comparators against clinical isolates collected all around the world. Main results of the TEST program on the in vitro activities of tigecyline against more 65,000 clinical isolates throughout the world are presented. The internet gives infectious diseases specialists and microbiologists the opportunity to have immediate access to continuously updated surveillance data. The TEST website should be helpful to clinicians to better select agents in severe infections, particularly for empirical treatment, that is at a time when the choice of the most appropriate antibiotic is essential for the outcome of the patient. [Copyright &y& Elsevier]

Abstract: For more than 20 years, hospital and community-acquired antimicrobial resistances regularly increase. In France, methicilline-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase-producing Enterobacteriaceae are the most common resistant pathogens. Previous hospitalisation, surgery, long length of stay, enteral feeding and antibiotic exposure are the main risk factors associated with nosocomial MRSA infections. To limit the emergence of resistances, control strategies have been implemented, based on isolation practices, healthcare workers education, strict hand hygiene and a controlled use of antibiotics. However, new antimicrobials acting by a novel mechanism of action are necessary in fighting the most resistant organisms. Therefore, the launch on the American market in June 2005 of tigecycline, a first-in-class glycylcycline indicated in the treatment of complicated skin and skin structure infections and complicated intra-abdominal infections, will provide to physicians a new therapeutic option against hospital or community-acquired resistant pathogens. The data presented to ICAAC indicate its expended broad spectrum of in vitro activity against Gram positives, Gram negatives, anaerobes and against number of difficult-to-treat resistant isolates, such as hospital or community-acquired MRSA, vancomycine resistant Enterococcus but also ESBL-producing organisms. [Copyright &y& Elsevier]

Abstract: We report a case of pulmonary and bloodstream infection due to multiresistant Acinetobacter baumannii six days after a severe trauma. Clinical condition transiently improved following antimicrobial treatment with ticarcillin–clavulanate and rifampicin. However, a septic shock developed on the fourth day due to the emergence of a strain only sensible to cotrimoxazole, colistin and tigecycline. Cure was achieved after a two week treatment with piperacillin–tazobactam, cotrimoxazole and tigecycline. This case shows that combined antimicrobial therapy including tigecycline can be relevant in some severe pulmonary infections due to multiresistant A. baumannii. [Copyright &y& Elsevier]

Introduction: Tigecycline is a relatively new antibiotic that have very limited valid indications. When no other alternative is available, this drug is widely used off label with promising results. The objective of this study is to summarize the different off label uses of tigecycline so that we can decide when and how to prescribe it in the absence of guidelines., Material and Methods: This study a revue of the literature collecting all the articles concerning the off label uses of tigecycline., Results: Tigecycline was widely prescribed, off label, to treat infections with controversial results. Randomised clinical trials were conducted to evaluate its use to treat pneumonia. The results for this indication have a respectable level of evidence. For the other indications, the data collected was insufficient to support tigecycline prescription. In fact, different protocols were used which makes it hard to evaluate the efficacy and to conclude to the best treatment regimen. A tendency to prescribe high doses of the molecule was noted in different studies. When prescribed off label, tigecycline prescriptions were associated with a higher mortality and incidence of side effects., Conclusion: The tigecycline remains a valid option for the treatment of infections dues to multi-resistant bacteria especially when other alternatives are scarce or in cases of renal failure., (Copyright © 2020 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Tigecycline (TGC), an antibiotic belonging to glycylcyclines, is active against Gram-positive bacteria, including multi-resistant bacteria, and most of the Gram-negative bacteria, including extended spectrum β-lactamase-producers (ESBL) and Acinetobacter sp. TGC is not active on Pseudomonas aeruginosa. The microbiological laboratory from the university hospital of Angers participates in the Tigecycline Evaluation and Surveillance Trial (TEST) since 2006. The objective of this study is to evaluate the effectiveness of TGC and of various comparators against nosocomial and community-acquired pathogens. We also evaluated the effectiveness of TGC on a panel of strains isolated between 2006 and 2009 in the university hospital of Angers. Minimum inhibitory concentrations (MIC) were determined using the microdilution method. A total of 760 clinical strains were tested. TGC had a very good activity against Gram-positive bacteria, with 100 % of susceptibility for all the strains tested, irrespective of their resistance profile. Concerning Gram-negative bacteria, TGC was active against 93 % of Enterobacteriaceae, with a MIC 90 not exceeding 2mg/L. Whole of the 20 strains ESBL-producers tested were susceptible to TGC. Acinetobacter sp. were also inhibited at low concentrations of TGC, with a MIC 90 of 1mg/L. These results suggest that TGC can be a useful therapeutic alternative, especially for infections involving multiresistant bacteria., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objectives: To report our experience of tigecycline use in a medical and surgical intensive care unit. To describe its prescription, microbiology findings, tolerance and efficacy., Study Design: Prospective, observational, single center study., Patients and Methods: All consecutive patients treated with tigecycline were included. Demography, indication of treatment, bacteriology before, during and in the month after treatment and ICU mortality were collected. The main endpoints were clinical and microbiological efficacy and tolerance., Results: Twenty-four patients were included. In half of the cases, tigecycline was prescribed in monotherapy for a complicated intra-abdominal infection. Overall tolerance of tigecycline was good. Clinical and microbiological cure was obtained in six cases, not obtained in nine, indeterminate in six cases and not evaluable in the three cases of prophylaxis. During the treatment, four bacteria commonly sensitives were shown to be resistant to tigecycline., Conclusion: Our pilot study on 24 patients suggests that tigecycline is well tolerated in critically ill patients. Clinical cure in severe infections was compromised in nine patients essentially because of resistant pathogens suggesting its prescription on antibiogram. However, the impact of association or the increasing doses in severe critically ill patients should be evaluated., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

There is a constant need for new antibacterial agents because of the unavoidable development of bacterial resistance that follows the introduction of antibiotics in clinical practice. As observed in many fields, innovation generally comes by series. For instance, a wide variety of broad-spectrum antibacterial agents became available between the 1970s and the 1990s, such as cephalosporins, penicillin/beta-lactamase inhibitor combinations, carbapenems, and fluoroquinolones. Over the last 2 decades, the arrival of new antibacterial drugs on the market has dramatically slowed, leaving a frequent gap between isolation of resistant pathogens and effective treatment options. In fact, many pharmaceutical companies focused on the development of narrow-spectrum antibiotics targeted at multidrug-resistant Gram-positive bacteria (e.g. methicillin-resistant Staphylococcus aureus, penicillin resistant Streptococcus pneumoniae, and vancomycin-resistant Enterococcus faecium). Therefore, multidrug-resistant Gram-negative bacteria (e.g. extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii) recently emerged and rapidly spread worldwide. Even if some molecules were developed, new molecules for infections caused by these multidrug-resistant Gram-negative bacteria remain remarkably scarce compared to those for Gram-positive infections. This review summarises the major microbiological, pharmacological, and clinical properties of systemic antibiotics recently marketed in France (i.e. linezolid, daptomycin, tigecycline, ertapenem, and doripenem) as well as those of antibacterial drugs currently in development (i.e. ceftobiprole, ceftaroline, dalbavancin, telavancin, oritavancin, iclaprim, and ramoplanin) or available in other countries (i.e. garenoxacin, sitafloxacin, and temocillin).

Though the increased resistance to antibiotics observed worldwide is not a major concern in France, treatment of methicillin-resistant S. aureus has important limitations. New antibiotics have recently been marketed or will soon be (quinupristin-dalfopristin, linelozide, tigecyclin, daptomycin, ceftobiprole, dalbavancin). Their role, which has been documented in several forms of acute infections, remains to be established in infective endocarditis. At present, only treatment of methicillin-resistant S. aureus right-sided endocarditis justifies the use of daptomycin, preferably in association with rifampicin, when the use of vancomycin is not possible or contraindicated.

Tigecycline Evaluation and Surveillance Trial (TEST) is an international surveillance study designed to assess the in vitro activity of tigecycline and 11 comparators against a range of important clinical pathogens from both the community and the hospital. The updated data obtained from the TEST program are integrated in a database server and available with a web application. The website has been designed to disseminate data collected from the international TEST program to the medical community and has been developed to be user-friendly. The use of this program-specific website can be made in a timely manner to extract antimicrobial resistance data of major microorganisms based on chosen selection criteria. This article describes how to use this web-based program for different analyse-types and the multiple options to display search results. Data can be presented in a table or as a graph or diagram, according to the source of the isolate, type of unit, resistance pattern of the pathogen. The website also allows the user to compare the data of antimicrobial testing at a national or regional level. It provides within a few minutes details on the activity of tigecycline and 11 comparators against clinical isolates collected all around the world. Main results of the TEST program on the in vitro activities of tigecyline against more 65,000 clinical isolates throughout the world are presented. The internet gives infectious diseases specialists and microbiologists the opportunity to have immediate access to continuously updated surveillance data. The TEST website should be helpful to clinicians to better select agents in severe infections, particularly for empirical treatment, that is at a time when the choice of the most appropriate antibiotic is essential for the outcome of the patient.

Antimicrobial resistance is an increasing public health concern, all the more as it is concurrently accompanied by limited antimicrobial drugs development, especially broad-spectrum antibiotics. Tigecycline, the first in the novel glycylcycline class to undergo clinical development, showed extensive in vitro activity against a broad range of Gram positive aerobes, among which Staphylococcus aureus, Streptococcus pneumoniae, and Gram negative pathogens, such as Haemophilus influenzae and enterobacteriae, despite these germs resistance to beta-lactams, vancomycin, and a number of other common antibiotics. Tigecycline is also active against some anaerobes. Data obtained in phase II clinical trials have shown good tolerance and efficacy of tigecycline administered by intravenous infusion in the treatment of complicated skin and skin structure infections and intra-abdominal infections. Should these results be confirmed by phase III clinical trials, tigecycline would provide a new option in the ongoing fight against resistant pathogens, which would usefully add to the present antibacterial armamentarium, particularly in severe or hospital treated infections.