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Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline
Prosthesis retention is not recommended for multidrug-resistant Acinetobacter prosthetic joint infection due to its high failure rate. Nevertheless, replacing the prosthesis implies high morbidity and prolonged hospitalization. Although tigecycline is not approved for the treatment of prosthetic joi...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5204012/ https://www.ncbi.nlm.nih.gov/pubmed/27883369 http://dx.doi.org/10.3947/ic.2016.48.4.324 |
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author | Vila, Andrea Pagella, Hugo Amadio, Claudio Leiva, Alejandro |
author_facet | Vila, Andrea Pagella, Hugo Amadio, Claudio Leiva, Alejandro |
author_sort | Vila, Andrea |
collection | PubMed |
description | Prosthesis retention is not recommended for multidrug-resistant Acinetobacter prosthetic joint infection due to its high failure rate. Nevertheless, replacing the prosthesis implies high morbidity and prolonged hospitalization. Although tigecycline is not approved for the treatment of prosthetic joint infection due to multidrug resistant Acinetobacter baumannii, its appropriate use may preclude prosthesis exchange. Since the area under the curve divided by the minimum inhibitory concentration is the best pharmacodynamic predictor of its efficacy, we used tigecycline at high dose, in order to optimize its efficacy and achieve implant retention in 3 patients who refused prosthesis exchange. All patients with prosthetic joint infections treated at our Institution are prospectively registered in a database. Three patients with early prosthetic joint infection of total hip arthroplasty due to multidrug resistant A. baumannii were treated with debridement, antibiotics and implant retention, using a high maintenance dose of tigecycline (100 mg every 12 hours). The cases were retrospectively reviewed. All patients signed informed consent for receiving off-label use of tigecycline. Tigecycline was well tolerated, allowing its administration at high maintenance dose for a median of 40 days (range 30–60). Two patients were then switched to minocycline at standard doses for a median of 3.3 months in order to complete treatment. Currently, none of the patients showed relapse. Increasing the dose of tigecycline could be considered as a means to better attain pharmacodynamic targets in patients with severe or difficult-to-treat infections. Tigecycline at high maintenance dose might be useful when retention of the implant is attempted for treatment for prosthetic joint infections due to multidrug resistant Acinetobacter. Although this approach might be promising, off-label use of tigecycline should be interpreted cautiously until prospective data are available. Tigecycline is probably under-dosed for the treatment of implant and biofilm associated infections. |
format | Online Article Text |
id | pubmed-5204012 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | The Korean Society of Infectious Diseases and Korean Society for Chemotherapy |
record_format | MEDLINE/PubMed |
spelling | pubmed-52040122017-01-04 Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline Vila, Andrea Pagella, Hugo Amadio, Claudio Leiva, Alejandro Infect Chemother Case Report Prosthesis retention is not recommended for multidrug-resistant Acinetobacter prosthetic joint infection due to its high failure rate. Nevertheless, replacing the prosthesis implies high morbidity and prolonged hospitalization. Although tigecycline is not approved for the treatment of prosthetic joint infection due to multidrug resistant Acinetobacter baumannii, its appropriate use may preclude prosthesis exchange. Since the area under the curve divided by the minimum inhibitory concentration is the best pharmacodynamic predictor of its efficacy, we used tigecycline at high dose, in order to optimize its efficacy and achieve implant retention in 3 patients who refused prosthesis exchange. All patients with prosthetic joint infections treated at our Institution are prospectively registered in a database. Three patients with early prosthetic joint infection of total hip arthroplasty due to multidrug resistant A. baumannii were treated with debridement, antibiotics and implant retention, using a high maintenance dose of tigecycline (100 mg every 12 hours). The cases were retrospectively reviewed. All patients signed informed consent for receiving off-label use of tigecycline. Tigecycline was well tolerated, allowing its administration at high maintenance dose for a median of 40 days (range 30–60). Two patients were then switched to minocycline at standard doses for a median of 3.3 months in order to complete treatment. Currently, none of the patients showed relapse. Increasing the dose of tigecycline could be considered as a means to better attain pharmacodynamic targets in patients with severe or difficult-to-treat infections. Tigecycline at high maintenance dose might be useful when retention of the implant is attempted for treatment for prosthetic joint infections due to multidrug resistant Acinetobacter. Although this approach might be promising, off-label use of tigecycline should be interpreted cautiously until prospective data are available. Tigecycline is probably under-dosed for the treatment of implant and biofilm associated infections. The Korean Society of Infectious Diseases and Korean Society for Chemotherapy 2016-12 2016-11-08 /pmc/articles/PMC5204012/ /pubmed/27883369 http://dx.doi.org/10.3947/ic.2016.48.4.324 Text en Copyright © 2016 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Vila, Andrea Pagella, Hugo Amadio, Claudio Leiva, Alejandro Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline |
title | Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline |
title_full | Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline |
title_fullStr | Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline |
title_full_unstemmed | Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline |
title_short | Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline |
title_sort | acinetobacter prosthetic joint infection treated with debridement and high-dose tigecycline |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5204012/ https://www.ncbi.nlm.nih.gov/pubmed/27883369 http://dx.doi.org/10.3947/ic.2016.48.4.324 |
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