Tigecycline Usage In Cancer Patients With Refractory Pneumonia: A Report On 38 Cases In A Single Institution

Roy F Chemaly, MD, MPH, Ray Hachem, MD, Santosh Hanmod, MD, Javier Adachi, MD, Holly Hogan, PharmD,Victor Mulanovich, MD, Dimitrios P Kontoyiannis, MD, Amar Safdar, MD, Issam I Raad, MD, Kenneth V.I. , Rolston, MD

Full title: 

Tigecycline Usage In Cancer Patients With Refractory Pneumonia: A Report On 38 Cases In A Single Institution

Abstract: 

Background: Tigecycline (TG), first in a new class of Glycylclines, is a novel agent approved for treatment of complicated soft tissue and intraabdominal infections in adults. Clinical data on the safety and efficacy of TG in cancer pts with pneumonia is lacking. Methods: We reviewed records of cancer pts with pneumonia treated with TG for >72 h between Sept’05 and Sept’06. Data collection included demographics, cancer type, indication for TG, side effects and outcome. Results: Thirty-eight pts with pneumonia were identified, 4 (10%) of them had ventilatorassociated pneumonia. Median age was 56 years (23-79 y). Most pts (28, 74%) had hematologic malignancies, including 14 allogeneic HSCT pts; 13 pts (34%) were neutropenic (ANC< 500/mm3). Twenty-six pts ( 68%) were in the ICU of whom 18 ( 69%) required ventilator support after development of pneumonia. Thirty-six (95%) pts received TG as second line agent (after failure of other broad-spectrum antibiotics) and in combination with an anti-pseudomonal drug(s) and the remaining 2 pts received it as a first line agent because of allergy to vancomycin and/or beta-lactams. Median duration of therapy was 11 d (4-35 d). Twenty-eight pts (74%) received TG for refractory pneumonia of unknown etiology and 10 pts (26%) for microbiologically documented pneumonia with multi-drug resistant organisms (MDRO) [MRSA, S. maltophilia, E. coli, VRE, and Acinetobacter]. Clinical response was noted in 24 pts (63%); including 6 of the 7 pts who had associated bacteremia and 5 pts with associated intra-abdominal infections. Eight of the 10 (80%) patients who had microbiologically documented pneumonia responded to the treatment The remainder 14 pts died (37%) The cause of death was multi organ failure and pneumonia of unknown etiology in 10 pts; MDR P. Aeuroginosa bacteremia, aspergillosis, S. maltophilia and VRE pneumonia in 1 each. Of the 9 pts who were not on anti-emetics and were not intubated, only 1 developed mild nausea. Diarrhea was noted in 1 pt. Conclusions: Combination of TG with anti-pseudomonal drug(s) appears to be an appropriate choice for treatment of refractory pneumonia secondary or not to MDRO in cancer patients, including HSCT recipients. Background 56256;56451; Management of hospital-acquired and community-acquired pneumonia in immunocompromised patients is becoming a significant challenge for healthcare providers. 56256;56451; Emergence of multi-drug resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum betalactamase- producing Enterobacteriaceae, Escherichia coli and Klebsiella pneumonia have aroused the concern regarding the use of right initial appropriate antimicrobial agent. 56256;56451; The introduction of new antimicrobial agents such as linezolid and quinupristin-dalfopristin has provided additional options for the treatment of infections due to resistant gram positive organisms. However, severe side-effects as well as emerging drug resistance associated with these agents may limit their widespread usage. 56256;56451; The development of novel and effective alternative agents, such as Tigecycline (TG), is needed. TG was found to be effective in treatment of complicated skin and skin structure infections as well as complicated intra-abdominal infections. 56256;56451; Data on efficacy and safety to TG in cancer patients with refractory pneumonia is lacking, therefore we are reviewing our experience at MD Anderson Cancer Center. Methods •We reviewed records of cancer pts with pneumonia treated with TG for >72 h between Sept’05 and Sept’06. • Data collection included demographics, cancer type, indication for TG, side effects and outcome. Table: 1 Patient characteristics and risk factors for infection Table: 2 Information about Tigecycline use Results 56256;56451; Thirty-eight pts with refractory pneumonia were identified including 25 males and 13 females. 56256;56451; Most of the patients [28(74%)] had hematological malignancies. Clinical Improvement: 24 (63%) 56256;56451; 12 (50%) patients were in ICU at the time of initiation of TG 56256;56451; 10 (42%) patients were on ventilator support and successfully weaned to spontaneous ventilation. 56256;56451; 3(13%) patients had ventilator associated pneumonia 56256;56451; 8 (33%) patients had neutropenia (ANC<500) Deaths: 14 (37%) 56256;56451; All ( 100%) the patients were in the ICU at the time of initiation of Table: 1 Patient characteristics and risk factors for infection Cases (n= 38) Age median (range) yrs 56 (23-79) yrs Gender M/F 25/13 Underlying Condition: Bone Marrow Transplant: 1 Allogeneic peripheral stem cell transplant 14 (37%) 11 ) y p ) ) q pp after development of pneumonia. Thirty-six (95%) pts received TG as second line agent (after failure of other broad-spectrum antibiotics) and in combination with an anti-pseudomonal drug(s) and the remaining 2 pts received it as a first line agent because of allergy to vancomycin and/or beta-lactams. Median duration of therapy was 11 d (4-35 d). Twenty-eight pts (74%) received TG for refractory pneumonia of unknown etiology and 10 pts (26%) for microbiologically documented pneumonia with multi-drug resistant organisms (MDRO) [MRSA, S. maltophilia, E. coli, VRE, and Acinetobacter]. Clinical response was noted in 24 pts (63%); including 6 of the 7 pts who had associated bacteremia and 5 pts with associated intra-abdominal infections. Eight of the 10 (80%) patients who had microbiologically documented pneumonia responded to the treatment The remainder 14 pts died (37%) The cause of death was multi organ failure and ) p TG 56256;56451; 13(93%) of them were on ventilator support secondary to respiratory insufficiency due to underlying pneumonia 56256;56451; 6 (43%) patients had neutropenia (ANC<500) 56256;56451; 1 (7%) patient had ventilator associated pneumonia Conclusions 56256;56451; Combination of tigecycline with anti-pseudomonal drug(s) appears to be an appropriate choice for treatment of refractory pneumonia secondary or not to MDRO in cancer patients, including HSCT recipients. 56256;56451; Tigecycline appears to be a safe therapeutic option without associated serious adverse effects in cancer patients.
2007

abstract No: 

P729

Full conference title: 

17th European Congress of Clinical Microbiology and Infectious Diseases and 25th International Congress of Chemotherapy