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Serratia
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Naheed S. Kanji, Umesh Narsinghani, Ritu A. Kumar
In recent years, tigecycline has been used as an alternative treatment option for MDR enterobacteria.85 This first-in-class glycylcycline has been shown to retain activity against ESBL-positive and AmpC-producing isolates.41
Tigecycline
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Tigecycline is the first glycylcycline that became available for clinical use and is a member of the tetracycline family. The chemical name for tigecycline is (4S,4aS,5aR,12aS)-9-[2-(tert-butylamino)acetamido]-4,7-bis(dimethylamino)- 1,4,4a,5,5a,6,11,12a-octahydro-3,10,12,12a-tet-rahydroxy- 1,11-dioxo-2-naphthacenecarboxamide. The empirical formula is C29H39N5O8 and the molecular weight is 585.65. Tigecycline is a semisynthetic derivative of minocycline; it has a glycylamido moiety attached to the C-9 position of minocycline (Sum et al., 1994; Hunter and Castaner, 2001). The molecular structure is shown in Figure 70.1. Tigecycline is produced by Wyeth under the trade name Tygacil®.
Enterococci: Resistance Update and Treatment Options
Published in Robert C. Owens, Lautenbach Ebbing, Antimicrobial Resistance, 2007
Tigecycline is the first approved agent of the glycylcycline class, a group closely related to the tetracyclines but synthetically modified to achieve an enhanced spectrum of activity against MRSA, other multi-resistant Gram-positive species, and many Gram-negative bacilli (113). Tigecycline is currently approved for CSSSI and intra-abdominal infection based on phase III studies showing comparability to standard comparator regimens. VRE were not included in these registration trials. However, tigecycline exhibits very low MICs for both vancomycin-susceptible and vancomycin-resistant clinical strains of E. faecium and E. faecalis (MIC90 = 0.012 mg/mL), although National Committee for Clinical Laboratory Standards breakpoints for vancomycin-resistant E. faecium strains are not yet established (114,115). Although clinical experience with tigecycline for VRE infection is not yet available, it appears to be a promising option particularly for intra-abdominal sites where it has shown comparable efficacy to meropenem in non-VRE monomicrobial and polymicrobial infection.
Leukocytosis induced by tigecycline in two patients with severe acute pancreatitis
Published in British Journal of Biomedical Science, 2021
X Li, L Li, T Liu, X Hai, B Sun
Tigecycline is the first member in the glycylcycline class of antibacterial agents which was approved by the U.S. Food and Drug Administration in 2005. The 9-t-butylglycylamido derivative of minocycline is used for the treatment of complicated skin and skin-structure infections, complicated intra-abdominal infections, and community-acquired bacterial pneumonia [1]. Tigecycline is the most sensitive drug used against extensively drug-resistant bacteria [2]. Currently, tigecycline associated adverse drug reactions are increasing, the most common being nausea, vomiting, diarrhoea and liver dysfunction [3], with a lower incidence of acute pancreatitis and hypofibrinogenemia [4–7]. Several cases have reported that minocycline may induce leukocytosis, but none have indicated a link between tetracycline antibiotics and leukocytosis [8–10]. Here, we describe two cases in which leukocytosis developed within a week of initiating tigecycline in infected pancreatic necrosis.
Escalating antimicrobial resistance among Enterobacteriaceae: focus on carbapenemases
Published in Expert Opinion on Pharmacotherapy, 2021
Joseph P. Lynch, Nina M. Clark, George G. Zhanel
Global spread of AMR is amplified by antibiotic use. Importantly, global antibiotic consumption has increased substantially over the past two decades [101]. Klein et al analyzed the trends and drivers of antibiotic consumption from 2000 to 2015 in 76 countries [101]. Between 2000 and 2015, global antibiotic consumption increased 65%. The increase was driven by low- and middle-income countries (LMICs), where rising consumption correlated with gross domestic product per capita (GDPPC) growth (p = 0.004). In high-income countries (HICs), overall consumption increased modestly, and there was no correlation with GDPPC. However, of particular concern was the rapid increase in the use of ‘last-resort’ compounds such as glycylcyclines, oxazolidinones, CPs, and polymyxins [101]. Antibiotic consumption in LMICs is rapidly converging to rates similar to HICs. Reducing global consumption is critical for reducing the threat of AMR. In Europe, outpatient antibiotic use was analyzed in 33 countries from 1997 to 2009. Total outpatient antibiotic use in 2009 varied by a factor of 3.8 between the countries with the highest defined daily dose (DDD) (38.6 in Greece) and lowest (10.2 in Romania) [102]. Additionally, the use of specific classes of antibiotics varied among countries [102]. Importantly, efforts are needed to curb inappropriate antibiotic use worldwide [103]. High-income countries must ensure their use of antimicrobials is appropriate to reduce selection for AMR. Surveillance across all countries is needed to monitor and respond to this emerging threat [90].
Therapeutic options for difficult-to-treat Acinetobacter baumannii infections: a 2020 perspective
Published in Expert Opinion on Pharmacotherapy, 2021
Matteo Bassetti, Laura Labate, Chiara Russo, Antonio Vena, Daniele Roberto Giacobbe
A tetracycline (minocycline) and a glycylcycline (tigecycline) are also considered among the options for treating severe DTR-AB infections [52,53]. Generally speaking, minocycline is an attractive option, owing to good tolerability, low cost, and availability of an oral formulation. In a recent meta-analysis of 10 observational studies (of which 9 retrospective), the lung was the most frequent site of infection, and mortality in patients treated either with minocycline monotherapy or with minocycline-including combined regimens was 21% (35/167) [52]. However, it should be noted that this result was the sum of deaths in the different studies, and it was thus unadjusted for between-study differences. Furthermore, the retrospective, observational nature of most included studies inherently implies a serious/critical risk of bias. Consequently, the use of minocycline for severe DTR-AB infections would still require support by dedicated RCT data before being universally recommended. Tigecycline is an important option for complicated intraabdominal infections (cIAI) due to tigecycline-susceptible DTR-AB, but its role for other more frequent types of DTR-AB infections such as VAP remains debated, due to the possible increased mortality reported in VAP patients treated with tigecycline, and based on pooled data from RCT [6]. Nonetheless, sometimes in clinical practice tigecycline may remain the only active agent for DTR-AB VAP, and its use at higher dosage than usual may thus be considered by clinicians in the absence of dependable alternatives [54–56].