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Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis

Severe infectious complications remain the main cause of mortality in leukemia patients due to a long period of profound neutropenia. Standardized regimens for antimicrobial, antifungal, and antiviral prophylaxis and therapy in neutropenic patients have improved infection-associated mortality. Never...

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Autores principales: Modemann, Franziska, Härterich, Steffen, Schulze zur Wiesch, Julian, Rohde, Holger, Lindeman, Nick Benjamin, Bokemeyer, Carsten, Fiedler, Walter, Ghandili, Susanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8868403/
https://www.ncbi.nlm.nih.gov/pubmed/35203731
http://dx.doi.org/10.3390/antibiotics11020128
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author Modemann, Franziska
Härterich, Steffen
Schulze zur Wiesch, Julian
Rohde, Holger
Lindeman, Nick Benjamin
Bokemeyer, Carsten
Fiedler, Walter
Ghandili, Susanne
author_facet Modemann, Franziska
Härterich, Steffen
Schulze zur Wiesch, Julian
Rohde, Holger
Lindeman, Nick Benjamin
Bokemeyer, Carsten
Fiedler, Walter
Ghandili, Susanne
author_sort Modemann, Franziska
collection PubMed
description Severe infectious complications remain the main cause of mortality in leukemia patients due to a long period of profound neutropenia. Standardized regimens for antimicrobial, antifungal, and antiviral prophylaxis and therapy in neutropenic patients have improved infection-associated mortality. Nevertheless, many patients are refractory to these multidrug approaches. Tigecycline is a last-resort antibiotic with a broad-spectrum activity; unfortunately, clinical experience in multidrug-resistant febrile neutropenia is limited. The aim was to evaluate the efficacy of tigecycline treatment in comparison to standard treatment in this patient cohort. In this single center analysis, we analyzed the clinical courses of 73 patients with acute leukemia and diagnosis of febrile neutropenia resistant to hospital-based multidrug escalation levels who continued on a standard approach without antibiotics as the last resort (n = 30) or were switched to tigecycline in addition to carbapenem treatment (n = 43). We observed comparable overall response rates (decrease in C-reactive protein or resolution of fever) in both patient cohorts. Switching the antibiotic approach to tigecycline showed lower absolute sepsis (33% vs. 47%, p = 0.235) and infection-associated mortality rates (5% vs. 13%, p = 0.221). Prospective larger randomized studies are necessary to underline these results and to be able to generate reliable statistics.
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spelling pubmed-88684032022-02-25 Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis Modemann, Franziska Härterich, Steffen Schulze zur Wiesch, Julian Rohde, Holger Lindeman, Nick Benjamin Bokemeyer, Carsten Fiedler, Walter Ghandili, Susanne Antibiotics (Basel) Article Severe infectious complications remain the main cause of mortality in leukemia patients due to a long period of profound neutropenia. Standardized regimens for antimicrobial, antifungal, and antiviral prophylaxis and therapy in neutropenic patients have improved infection-associated mortality. Nevertheless, many patients are refractory to these multidrug approaches. Tigecycline is a last-resort antibiotic with a broad-spectrum activity; unfortunately, clinical experience in multidrug-resistant febrile neutropenia is limited. The aim was to evaluate the efficacy of tigecycline treatment in comparison to standard treatment in this patient cohort. In this single center analysis, we analyzed the clinical courses of 73 patients with acute leukemia and diagnosis of febrile neutropenia resistant to hospital-based multidrug escalation levels who continued on a standard approach without antibiotics as the last resort (n = 30) or were switched to tigecycline in addition to carbapenem treatment (n = 43). We observed comparable overall response rates (decrease in C-reactive protein or resolution of fever) in both patient cohorts. Switching the antibiotic approach to tigecycline showed lower absolute sepsis (33% vs. 47%, p = 0.235) and infection-associated mortality rates (5% vs. 13%, p = 0.221). Prospective larger randomized studies are necessary to underline these results and to be able to generate reliable statistics. MDPI 2022-01-19 /pmc/articles/PMC8868403/ /pubmed/35203731 http://dx.doi.org/10.3390/antibiotics11020128 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Modemann, Franziska
Härterich, Steffen
Schulze zur Wiesch, Julian
Rohde, Holger
Lindeman, Nick Benjamin
Bokemeyer, Carsten
Fiedler, Walter
Ghandili, Susanne
Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis
title Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis
title_full Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis
title_fullStr Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis
title_full_unstemmed Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis
title_short Efficacy of Tigecycline as Salvage Therapy in Multidrug-Resistant Febrile Neutropenia in Patients with Acute Leukemia—A Single Center Analysis
title_sort efficacy of tigecycline as salvage therapy in multidrug-resistant febrile neutropenia in patients with acute leukemia—a single center analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8868403/
https://www.ncbi.nlm.nih.gov/pubmed/35203731
http://dx.doi.org/10.3390/antibiotics11020128
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