Tigecycline use in critically ill patients: a multicentre prospective observational study in the intensive care setting

PURPOSE: This prospective observational study aimed at describing prescription patterns of tigecycline and patient outcomes in 26 French intensive care units (ICU). METHODS: Data of consecutive cases of adult patients treated with tigecycline were collected from the initiation until 7 days after the end of treatment. Response to treatment was classified as success, failure or undetermined and analyses were presented according to severity (SOFA score <7 or ≥7). Survival was recorded at 28 days. RESULTS: A total of 156 patients were included (64 % male, age 60 ± 15 years). At inclusion, 53 % had a SOFA score ≥7; 93 % had received prior anti-infective agents. Tigecycline was given as first-line treatment in 47 % of patients, mostly in combination (67 %), for intra-abdominal (IAI 56 %), skin and soft tissue (SSTI 19 %) or other infections. A total of 76 % of the treated infections were hospital-acquired. Bacteraemia was reported in 12 % of patients. Median treatment duration was 9 days. Tigecycline was prematurely stopped in 42 % patients. The global success rate was 60 % at the end of treatment, and significantly higher with treatment duration more than 9 days (76 vs. 47 %, P < 0.001). Success rate was 65 % for patients alive at the end of treatment. Success rates tended to decrease with illness severity, immunosuppression, bacteraemia and obesity. Survival rate at day 28 was 85 % in the whole cohort and significantly higher in the less severely ill patients (P < 0.001). CONCLUSIONS: Tigecycline success rates appear comparable to those reported in clinical studies in ICU with severe infections. Tigecycline could be an alternative in ICU patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00134-014-3323-7) contains supplementary material, which is available to authorized users.