Background
Methods
Setting
Study design, patients and treatments
Microbiology
Demography and comorbidity
Clinical conditions and outcomes
Statistical methods
Results
Patients, demography and concomitant diseases
Variables | TG groupa | SB groupa |
p
| OR (95 % CI) |
---|---|---|---|---|
n = 84 | n = 84 | |||
Demographic parameters | ||||
Age, yr | 69.6 (15.9) | 70.6 (15.6) | 0.689 | |
Male gender | 57 (67.9) | 58 (69.0) | 0.868 | 0.946 (0.494–1.814) |
Concomitant diseases | ||||
Hepatic dysfunction | 12 (14.3) | 6 (7.1) | 0.134 | 2.167 (0.773–6.075) |
Renal insufficiency | 32 (38.1) | 32 (38.1) | 1.000 | 1.000 (0.536–1.864) |
Chronic pulmonary disease | 22 (26.2) | 20 (23.8) | 0.722 | 1.135 (0.564–2.284) |
Heart disease | 13 (15.5) | 7 (8.3) | 0.153 | 2.014 (0.761–5.333) |
Diabetes mellitus | 26 (31.0) | 35 (41.7) | 0.149 | 0.628 (0.333–1.183) |
Immune compromise | 13 (15.5) | 11 (13.1) | 0.659 | 1.215 (0.511–2.891) |
Malignancy | 15 (17.9) | 20 (23.8) | 0.342 | 0.696 (0.328–1.474) |
Surgery | 22 (26.2) | 15 (17.9) | 0.193 | 1.632 (0.778–3.423) |
Clinical conditions | ||||
APACHE II Score | 20.1 (6.1) | 20.1 (6.1) | 1.000 | |
Ventilator use | 58 (69.0) | 75 (89.3) | 0.001 | 0.268 (0.117–0.615) |
Pneumonia involving bilateral lung | 51 (60.7) | 67 (79.8) | 0.007 | 0.392 (0.197–0.781) |
Polymicrobial pneumonia, overall | 66 (78.6) | 62 (73.8) | 0.469 | 1.301 (0.638–2.654) |
Polymicrobial pneumonia, coinfection with | ||||
MRSA | 26 (31.0) | 34 (40.5) | 0.198 | 0.659 (0.349–1.245) |
Pseudomonas aeruginosa | 33 (39.3) | 23 (27.4) | 0.102 | 1.716 (0.896–3.285) |
Klebsiella spp.b | 12 (14.3) | 5 (6.0) | 0.073 | 2.633 (0.884–7.840) |
Escherichia coli | 2 (2.4) | 2 (2.4) | 1.000 | 1.000 (0.138–7.270) |
Enterobacter spp.c | 2 (2.4) | 2 (2.4) | 1.000 | 1.000 (0.138–7.270) |
Serratia marcescens | 10 (11.9) | 1 (1.2) | 0.005 | 11.216 (1.402–89.724) |
Stenotrophomonas maltophilia | 6 (7.1) | 15 (17.9) | 0.036 | 0.354 (0.130–0.962) |
Multisite infections, overall | 33 (39.3) | 35 (41.7) | 0.753 | 0.906 (0.489–1.678) |
With urinary tract infection | 13 (15.5) | 19 (22.6) | 0.238 | 0.626 (0.287–1.369) |
With catheter related infection | 2 (2.4) | 10 (11.9) | 0.017 | 0.180 (0.038–0.851) |
With soft tissue and wound infection | 10 (11.9) | 5 (6.0) | 0.176 | 2.135 (0.697–6.540) |
With intra-abdominal infection | 8 (9.5) | 4 (4.8) | 0.231 | 2.105 (0.609–7.279) |
With invasive fungal infectiond | 12 (14.3) | 4 (4.8) | 0.035 | 3.333 (1.029–10.799) |
Bacteremia during treatment | 4 (4.8) | 0 (0.0) | 0.121 | 9.447 (0.501–178.291) |
With TG or SB-resistant MDR Acb complexe | 16 (19.0) | 43 (51.2) | < 0.0001 | 0.224 (0.112–0.448) |
Treatment | ||||
Duration, days | 14.6 (5.4) | 16.4 (7.6) | 0.150 | |
Combination therapy, overall | 45 (53.6) | 71 (84.5) | < 0.0001 | 0.211 (0.102–0.439) |
With cephalosporins | 20 (23.8) | 8 (9.5) | 0.013 | 2.969 (1.226–7.192) |
With colistin | 12 (14.3) | 0 (0.0) | < 0.0001 | 29.138 (1.695–500.773) |
With carbapenems | 5 (6.0) | 60 (71.4) | < 0.0001 | 0.025 (0.009–0.070) |
With aminoglycosides | 7 (8.3) | 1 (1.2) | 0.064 | 7.545 (0.907–62.744) |
With fluoroquinolones | 12 (14.3) | 4 (4.8) | 0.035 | 3.333 (1.029–10.799) |
Delayed treatment | 35 (41.7) | 22 (26.2) | 0.034 | 2.013 (1.049–3.863) |
Outcomes | ||||
Airway eradication of MDR Acb complex without relapsef | 26 (33.3) | 47 (63.5) | < 0.0001 | 0.287 (0.147–0.560) |
Defervescence | 54 (64.3) | 76 (90.5) | < 0.0001 | 0.189 (0.081–0.445) |
Image study of lung | ||||
Improvement | 37 (44.0) | 39 (46.4) | 0.757 | 0.908 (0.495–1.668) |
Stationary | 32 (38.1) | 22 (26.2) | 0.099 | 1.734 (0.900–3.342) |
Deterioration | 15 (17.9) | 23 (27.4) | 0.140 | 0.577 (0.276–1.204) |
Clinical resolution of pneumonia | 56 (66.7) | 56 (66.7) | 1.000 | 1.000 (0.526–1.899) |
Mortality during treatment | 21 (25.0) | 15 (17.9) | 0.259 | 1.533 (0.728–3.231) |
30-day mortality | 28 (33.3) | 25 (29.8) | 0.618 | 1.180 (0.615–2.264) |
Clinical conditions
Treatment
Outcomes
The predictor for mortality during treatment
Variables | Deceaseda | Survivorsa | Univariate | Multivariateb | |
---|---|---|---|---|---|
n = 36 | n = 132 |
p
|
p
| Adjusted OR (95 % CI) | |
Demographic parameters | |||||
Age, yr | 69.8 (14.7) | 70.2 (16.0) | 0.658 | ||
Male gender | 26 (72.2) | 89 (67.4) | 0.583 | ||
Concomitant diseases | |||||
Hepatic dysfunction | 6 (16.7) | 12 (9.1) | 0.224 | ||
Renal insufficiency | 15 (41.7) | 49 (37.1) | 0.619 | ||
Chronic pulmonary disease | 6 (16.7) | 36 (27.3) | 0.193 | ||
Heart disease | 6 (16.7) | 14 (10.6) | 0.383 | ||
Diabetes mellitus | 14 (38.9) | 47 (35.6) | 0.717 | ||
Immune compromise | 5 (13.9) | 19 (14.4) | 0.939 | ||
Malignancy | 11 (30.6) | 24 (18.2) | 0.105 | ||
Surgery | 11 (30.6) | 26 (19.7) | 0.163 | ||
Clinical conditions | |||||
APACHE II Score | 20.3 (7.3) | 20.1 (5.8) | 0.858 | ||
Ventilator use | 26 (72.2) | 107 (81.1) | 0.247 | ||
Bilateral pneumonia | 30 (83.3) | 88 (66.7) | 0.053 | 0.047 | 2.717 (1.015–7.272) |
Polymicrobial pneumonia | 29 (80.6) | 99 (75.0) | 0.488 | ||
With MRSA | 10 (27.8) | 50 (37.9) | 0.262 | ||
With Pseudomonas aeruginosa | 14 (38.9) | 42 (31.8) | 0.425 | ||
With Klebsiella spp. | 6 (16.7) | 11 (8.3) | 0.207 | ||
With Serratia marcescens | 3 (8.3) | 8 (6.1) | 0.704 | ||
With Stenotrophomanas maltophilia | 6 (16.7) | 15 (11.4) | 0.400 | ||
Multisite infections | 18 (50.0) | 50 (37.9) | 0.189 | ||
With urinary tract infection | 8 (22.2) | 24 (18.2) | 0.584 | ||
With catheter related infection | 2 (5.6) | 10 (7.6) | 1.000 | ||
With skin and soft tissue infection | 6 (16.7) | 9 (6.8) | 0.094 | 0.214 | 2.070 (0.657–6.521) |
With intra-abdominal infection | 3 (8.3) | 9 (6.8) | 0.721 | ||
With invasive fungal infection | 3 (8.3) | 13 (9.8) | 1.000 | ||
Microbiology | |||||
MDR Acb complex with TG or SB resistancec | 7 (19.4) | 52 (39.4) | 0.026 | 0.079 | 0.426 (0.164–1.103) |
Airway eradication of MDR Acb complexd | 11 (42.3) | 62 (49.2) | 0.521 | ||
Bacteremia during treatment | 2 (5.6) | 2 (1.5) | 0.201 | ||
Treatment | |||||
Tigecycline-based treatment | 21 (58.3) | 63 (47.7) | 0.259 | 0.451 | 1.371 (0.604–3.116) |
Duration, days | 15.6 (7.9) | 15.5 (6.2) | 0.519 | ||
Combination therapy | 25 (69.4) | 91 (68.9) | 0.954 | ||
With cephalosporins | 6 (16.7) | 22 (16.7) | 1.000 | ||
With carbapenems | 12 (33.3) | 53 (40.2) | 0.457 | ||
With fluoroquinolones | 2 (5.6) | 14 (10.6) | 0.527 | ||
With colistin | 3 (8.3) | 9 (6.8) | 0.721 | ||
Delayed treatment | 9 (25.0) | 48 (36.4) | 0.202 |
Variables | Odds ratio | 95 % confidence interval |
p
|
---|---|---|---|
Model Aa | |||
With skin and soft tissue infection | 2.041 | 0.644–6.466 | 0.225 |
MDR Acb complex with TG or SB resistance | 0.418 | 0.160–1.092 | 0.075 |
Bilateral pneumonia | 2.663 | 0.987–7.186 | 0.053 |
Tigecycline-based treatment | 1.405 | 0.608–3.245 | 0.426 |
Combination therapy | 1.133 | 0.472–2.720 | 0.779 |
Model Bb | |||
With skin and soft tissue infection | 2.071 | 0.657–6.523 | 0.214 |
MDR Acb complex with TG or SB resistance | 0.426 | 0.163–1.114 | 0.082 |
Bilateral pneumonia | 2.717 | 1.007–7.329 | 0.048 |
Tigecycline-based treatment | 1.373 | 0.497–3.795 | 0.541 |
Combination with carbapenem | 1.002 | 0.346–2.905 | 0.997 |
Model Cc | |||
With skin and soft tissue infection | 2.002 | 0.624–6.425 | 0.243 |
MDR Acb complex with TG or SB resistance | 0.420 | 0.161–1.090 | 0.075 |
Bilateral pneumonia | 2.795 | 1.028–7.600 | 0.044 |
Tigecycline-based treatment | 1.430 | 0.608–3.363 | 0.413 |
Combination with colistin | 0.783 | 0.178–3.444 | 0.746 |
Model D | |||
With skin and soft tissue infection | 2.035 | 0.639–6.485 | 0.230 |
MDR Acb complex with TG or SB resistance | 0.428 | 0.165–1.111 | 0.081 |
Bilateral pneumonia | 2.711 | 1.013–7.254 | 0.047 |
Tigecycline-based treatment | 1.362 | 0.598–3.102 | 0.462 |
Polymicrobial pneumonia | 1.109 | 0.426–2.884 | 0.833 |
Model E | |||
With skin and soft tissue infection | 1.979 | 0.612–6.405 | 0.254 |
MDR Acb complex with TG or SB resistance | 0.422 | 0.160–1.110 | 0.080 |
Bilateral pneumonia | 2.781 | 1.014–7.624 | 0.047 |
Tigecycline-based treatment | 1.422 | 0.498–4.056 | 0.510 |
Polymicrobial pneumonia | 1.086 | 0.413–2.853 | 0.868 |
Combination with colistin | 0.797 | 0.179–3.557 | 0.767 |
Combination with carbapenem | 1.006 | 0.346–2.921 | 0.991 |
Monotherapy of tigecycline and sulbactam
Variables | TG groupa | SB groupa |
p
| Deceasedab | Survivorsa |
p
|
---|---|---|---|---|---|---|
n = 39 | n = 13 | n = 11 | n = 41 | |||
Demographic parameters | ||||||
Age, yr | 71.4 (15.0) | 68.7 (19.9) | 0.899 | 75.3 (12.0) | 69.5 (17.1) | 0.439 |
Male gender | 25 (64.1) | 10 (76.9) | 0.506 | 8 (72.7) | 27 (65.9) | 1.000 |
Concomitant diseases | ||||||
Hepatic dysfunction | 3 (7.7) | 0 (0.0) | 0.564 | 1 (9.1) | 2 (4.9) | 0.518 |
Renal insufficiency | 10 (25.6) | 4 (30.8) | 0.729 | 1 (9.1) | 13 (31.7) | 0.251 |
Chronic pulmonary disease | 11 (28.2) | 4 (30.8) | 1.000 | 4 (36.4) | 11 (26.8) | 0.709 |
Heart disease | 6 (15.4) | 1 (7.7) | 0.664 | 2 (18.2) | 5 (12.2) | 0.630 |
Diabetes mellitus | 9 (23.1) | 4 (30.8) | 0.714 | 3 (27.3) | 10 (24.4) | 1.000 |
Immune compromise | 8 (20.5) | 1 (7.7) | 0.420 | 2 (18.2) | 7 (17.1) | 1.000 |
Malignancy | 8 (20.5) | 3 (23.1) | 1.000 | 4 (36.4) | 7 (17.1) | 0.216 |
Surgery | 9 (23.1) | 1 (7.7) | 0.419 | 2 (18.2) | 8 (19.5) | 1.000 |
Clinical conditions | ||||||
APACHE II Score | 17.0 (6.1) | 18.2 (6.0) | 0.557 | 17.1 (6.8) | 17.3 (5.9) | 0.904 |
Ventilator use | 21 (53.8) | 11 (84.6) | 0.048 | 6 (54.5) | 26 (63.4) | 0.730 |
Bilateral pneumonia | 18 (46.2) | 12 (92.3) | 0.004 | 8 (72.7) | 22 (53.7) | 0.319 |
Polymicrobial pneumonia | 31 (79.5) | 9 (69.2) | 0.466 | 9 (81.8) | 31 (75.6) | 1.000 |
With MRSA | 20 (51.3) | 6 (46.2) | 0.749 | 5 (45.5) | 21 (51.2) | 0.734 |
With Pseudomonas aeruginosa | 14 (35.9) | 3 (23.1) | 0.506 | 5 (45.5) | 12 (29.3) | 0.470 |
With Klebsiella spp. | 7 (17.9) | 1 (7.7) | 0.662 | 1 (9.1) | 7 (17.1) | 1.000 |
With Serratia marcescens | 5 (12.8) | 1 (7.7) | 1.000 | 1 (9.1) | 5 (12.2) | 1.000 |
With Stenotrophomanas maltophilia | 3 (7.7) | 3 (23.1) | 0.157 | 1 (9.1) | 5 (12.2) | 1.000 |
Multisite infections | 14 (35.9) | 5 (38.5) | 1.000 | 4 (36.4) | 15 (36.6) | 1.000 |
With urinary tract infection | 7 (17.9) | 3 (23.1) | 0.697 | 2 (18.2) | 8 (19.5) | 1.000 |
With catheter related infection | 0 (0.0) | 2 (15.4) | 0.059 | 1 (9.1) | 1 (2.4) | 0.382 |
With skin and soft tissue infection | 3 (7.7) | 1 (7.7) | 1.000 | 1 (9.1) | 3 (7.3) | 1.000 |
With intra-abdominal infection | 4 (10.3) | 0 (0.0) | 0.561 | 0 (0.0) | 4 (9.8) | 0.567 |
With invasive fungal infection | 6 (15.4) | 0 (0.0) | 0.317 | 1 (9.1) | 5 (12.2) | 1.000 |
Microbiology | ||||||
MDR Acb complex with TG or SB resistancec | 6 (15.4) | 4 (30.8) | 0.244 | 1 (9.1) | 9 (22.0) | 0.668 |
Airway eradication of MDR Acb complexd | 12 (34.3) | 8 (88.9) | 0.006 | 4 (57.1) | 16 (43.2) | 0.684 |
Bacteremia during treatment | 2 (5.1) | 0 (0.0) | 1.000 | 1 (9.1) | 1 (2.4) | 0.382 |
Treatment | ||||||
Tigecycline-based treatment | 7 (63.6) | 32 (78.0) | 0.435 | |||
Duration, days | 13.8 (5.1) | 12.7 (5.6) | 0.293 | 11.9 (3.0) | 14.0 (5.6) | 0.398 |
Delayed treatment | 20 (51.3) | 5 (38.5) | 0.423 | 5 (45.5) | 20 (48.8) | 0.845 |
Outcomes | ||||||
Clinical resolution of pneumonia | 26 (66.7) | 8 (61.5) | 0.747 | |||
Mortality during treatment | 7 (17.9) | 4 (30.8) | 0.435 | |||
30-day mortality | 10 (25.6) | 7 (53.8) | 0.089 |