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The efficacy and safety of tigecycline for the treatment of bloodstream infections: a systematic review and meta-analysis

View Article: PubMed Central - PubMed

ABSTRACT

Patients with bloodstream infections (BSI) are associated with high mortality rates. Due to tigecycline has shown excellent in vitro activity against most pathogens, tigecycline is selected as one of the candidate drugs for the treatment of multidrug-resistant organisms infections. The purpose of this study was to evaluate the effectiveness and safety of the use of tigecycline for the treatment of patients with BSI. The PubMed and Embase databases were systematically searched, to identify published studies, and we searched clinical trial registries to identify completed unpublished studies, the results of which were obtained through the manufacturer. The primary outcome was mortality, and the secondary outcomes were the rate of clinical cure and microbiological success. 24 controlled studies were included in this systematic review. All-cause mortality was lower with tigecycline than with control antibiotic agents, but the difference was not significant (OR 0.85, [95% confidence interval (CI) 0.31–2.33; P = 0.745]). Clinical cure was significantly higher with tigecycline groups (OR 1.76, [95% CI 1.26–2.45; P = 0.001]). Eradication efficiency did not differ between tigecycline and control regimens, but the sample size for these comparisons was small. Subgroup analyses showed good clinical cure result in bacteremia patients with CAP. Tigecycline monotherapy was associated with a OR of 2.73 (95% CI 1.53–4.87) for mortality compared with tigecycline combination therapy (6 studies; 250 patients), without heterogeneity. Five studies reporting on 398 patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae BSI showed significantly lower mortality in the tigecycline arm than in the control arm. The combined treatment with tigecycline may be considered the optimal option for severely ill patients with BSI.

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The efficacy of tigecycline, as compared with other antibiotics, in treating infections caused by BSI
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Fig2: The efficacy of tigecycline, as compared with other antibiotics, in treating infections caused by BSI

Mentions: There was a significant differences were observed between the tigecycline and control groups in this regard (OR 1.76, [95% CI 1.26–2.45; P = 0.001]; I2 = 29.2%; [P = 0.159]; Fig. 2). Clinical cure was significantly higher in the tigecycline population. In the subgroup analysis, for analysis by type of infection, without statistical significance was found in patients with cIAI (OR 0.97, [95% CI 0.52–1.80; P = 0.919]; I2 = 0.0%; [P = 0.953]) and cSSSI (OR 0.71, [95% CI 0.26–1.90; P = 0.494]; I2 = 0.0%; [P = 0.821]), but in trials assessing patients with CAP, for the rate of clinical cure, the efficacy of tigecycline was better than that of comparator regimens (OR 2.44, [95% CI 1.20–4.94; P = 0.013]; I2 = 0.0%; [P = 0.821]). As shown in Fig. 2.Fig. 2


The efficacy and safety of tigecycline for the treatment of bloodstream infections: a systematic review and meta-analysis
The efficacy of tigecycline, as compared with other antibiotics, in treating infections caused by BSI
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5382384&req=5

Fig2: The efficacy of tigecycline, as compared with other antibiotics, in treating infections caused by BSI
Mentions: There was a significant differences were observed between the tigecycline and control groups in this regard (OR 1.76, [95% CI 1.26–2.45; P = 0.001]; I2 = 29.2%; [P = 0.159]; Fig. 2). Clinical cure was significantly higher in the tigecycline population. In the subgroup analysis, for analysis by type of infection, without statistical significance was found in patients with cIAI (OR 0.97, [95% CI 0.52–1.80; P = 0.919]; I2 = 0.0%; [P = 0.953]) and cSSSI (OR 0.71, [95% CI 0.26–1.90; P = 0.494]; I2 = 0.0%; [P = 0.821]), but in trials assessing patients with CAP, for the rate of clinical cure, the efficacy of tigecycline was better than that of comparator regimens (OR 2.44, [95% CI 1.20–4.94; P = 0.013]; I2 = 0.0%; [P = 0.821]). As shown in Fig. 2.Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Patients with bloodstream infections (BSI) are associated with high mortality rates. Due to tigecycline has shown excellent in vitro activity against most pathogens, tigecycline is selected as one of the candidate drugs for the treatment of multidrug-resistant organisms infections. The purpose of this study was to evaluate the effectiveness and safety of the use of tigecycline for the treatment of patients with BSI. The PubMed and Embase databases were systematically searched, to identify published studies, and we searched clinical trial registries to identify completed unpublished studies, the results of which were obtained through the manufacturer. The primary outcome was mortality, and the secondary outcomes were the rate of clinical cure and microbiological success. 24 controlled studies were included in this systematic review. All-cause mortality was lower with tigecycline than with control antibiotic agents, but the difference was not significant (OR 0.85, [95% confidence interval (CI) 0.31–2.33; P = 0.745]). Clinical cure was significantly higher with tigecycline groups (OR 1.76, [95% CI 1.26–2.45; P = 0.001]). Eradication efficiency did not differ between tigecycline and control regimens, but the sample size for these comparisons was small. Subgroup analyses showed good clinical cure result in bacteremia patients with CAP. Tigecycline monotherapy was associated with a OR of 2.73 (95% CI 1.53–4.87) for mortality compared with tigecycline combination therapy (6 studies; 250 patients), without heterogeneity. Five studies reporting on 398 patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae BSI showed significantly lower mortality in the tigecycline arm than in the control arm. The combined treatment with tigecycline may be considered the optimal option for severely ill patients with BSI.

No MeSH data available.


Related in: MedlinePlus