Hematologic Malignancies and Carbapenem Resistance: A Multicentre Retrospective Study from Chinese People

Background: Tigecycline has broad spectrum activity against multidrug-resistant (MDR) bacteria, but few investigations of tigecycline in febrile neutropenic (FN) patients with malignancy are available. This study attempts to investigate the efficacy and safety of tigecycline in FN and carbapenem resisant patients with hematologic malignancies.

Methods: The study of 109 patients with hematologic diseases and FN were retrospectively analyzed. They are unresponsive to carbapenems for 3~5 days before receiving tigecycline (loading dose 100 mg; then 50 mg every 12 hours). Clinical response to treatment was defined as clinical cure, improvement or failure. Meanwhile, the adverse events were documented.

Results: The median duration of neutropenia was 15 days (ranged from 1 to 83d). Out of 109 patients, 96 (88.1%) had respiratory infection, while 33 (30.3%) had bloodstream infection. The total response rate of tigecycline was 65.1%. The bacterial eradication rates and bacterial hypothetical eradication were 25.9% and 24.1%, respectively. The clinical effective rate was 85.7% when tigecycline was administered for more than 9 days, while just 48.3% when administered for less than 9 days (p< 0.001). Patients with bloodstream infection got a worse efficacy than those without (41.2% vs 69.6%, p=0.024). For patients whose absolute neutrophil counts were less than 0.1×10⁹/L, the clinical effective rate decreased obviously (59.8%, vs.86.4%, p=0.019). The side-effects were well tolerated. No lethal adverse events were observed.

Conclusions: Our results demonstrated tigecycline was effective and safe for patients unresponsive to carbapenems with FN, combination and prolonged duration of tigecycline is recommended, and these results need to be further studied.