Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug 6;19(1):35.
doi: 10.1186/s12941-020-00377-9.

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Rima Moghnieh  1   2 , Dania Abdallah  3 , Lyn Awad  3 , Marwa Jadayel  4 , Nicholas Haddad  5 , Hani Tamim  6 , Aline Zaiter  7 , Diana-Caroline Awwad  7 , Loubna Sinno  8 , Salam El-Hassan  9 , Rawad Lakkis  10 , Rabab Khalil  11 , Tamima Jisr  12
Affiliations

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Rima Moghnieh et al. Ann Clin Microbiol Antimicrob. .

Abstract

Background: A drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP.

Methods: This is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP].

Results: Tigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001).

Conclusion: The drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.

Keywords: Antibiotic stewardship; FDA-approved indication; Lebanon; Off-label use; Tigecycline.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Quarterly variation of tigecycline consumption (DDD/1000 PD) before and after the antibiotic stewardship program implementation at Makassed General Hospital. ASP antibiotic stewardship program, DDD defined daily dose, PD patient days, ∆ change in
See this image and copyright information in PMC

References

    1. Mendes RE, Farrell DJ, Sader HS, Jones RN. Comprehensive assessment of tigecycline activity tested against a worldwide collection of Acinetobacter spp. (2005–2009) Diagn Microbiol Infect Dis. 2010;68:307–311. - PubMed
    1. Balode A, Punda-Polic V, Dowzicky MJ. Antimicrobial susceptibility of gram-negative and gram-positive bacteria collected from countries in Eastern Europe: results from the Tigecycline Evaluation and Surveillance Trial (T.E.S.T) 2004–2010. Int J Antimicrob Agents. 2013;41:527–535. - PubMed
    1. Sader HS, Castanheira M, Flamm RK, Mendes RE, Farrell DJ, Jones RN. Tigecycline activity tested against carbapenem-resistant Enterobacteriaceae from 18 European nations: results from the SENTRY surveillance program (2010–2013) Diagn Microbiol Infect Dis. 2015;83:183–186. - PubMed
    1. Zarrilli R, Vitale D, Di Popolo A, Bagattini M, Daoud Z, Khan AU, et al. A plasmid-borne blaOXA-58 gene confers imipenem resistance to Acinetobacter baumannii isolates from a Lebanese hospital. Antimicrob Agents Chemother. 2008;52:4115–4120. - PMC - PubMed
    1. Hammoudi D, Moubareck CA, Hakime N, Houmani M, Barakat A, Najjar Z, et al. Spread of imipenem-resistant Acinetobacter baumannii co-expressing OXA-23 and GES-11 carbapenemases in Lebanon. Int J Infect Dis. 2015;36(56–61):17. - PubMed