Efficacy and Safety of Tigecycline for Complicated Urinary Tract Infection

A Systematic Review

Yang-Xi Liu; Ke-Jia Le; Hong-Yao Shi; Zai-Li Zhang; Min Cui; Han Zhong; Yue-Tian Yu; Zhi-Chun Gu

Disclosures

Transl Androl Urol. 2021;10(1):292-299. 

In This Article

Abstract and Introduction

Abstract

Background: Facing the global threat of emerging resistance to antibiotics, tigecycline, a novel glycylcycline antibiotic, is developed to against multidrug-resistant pathogens, but not recommended for the treatment of complicated urinary tract infection (cUTI). We performed a summary of the literatures to characterize and evaluate the efficacy and safety of tigecycline in patients with cUTI.

Methods: We searched PubMed, EMBASE, Cochrane and Clinical Trials using appropriate syntax to retrieve potential articles up to Jan 2020. General information, pathogen, medication regimen, comorbidities of patients from eligible literatures were recorded. Univariate logistic regression analysis was used to detect the potential factors associated with clinical cure.

Results: Nineteen articles comprising 31 cases were included. The subpopulation with transplantation (25.8% of the patients) was the most common comorbidity, and cUTIs were mainly caused by Klebsiella pneumoniae (K. pneumoniae) (48.28%) in our research. Tigecycline 100 mg per day as monotherapy was most common. Clinical cure was reported as majority (77.4%), and microbiological eradication cases accounted for the most (65.2%) among the clinical cure cases. Univariate analysis showed that K. pneumoniae caused cUTI and tigecycline as a single treatment have significant meaning to clinical outcomes (P=0.044 and P=0.034, respectively).

Conclusions: Clinical and microbiological outcomes of tigecycline treatment revealed high rate of successful response. Tigecycline monotherapy may have a role in the treatment of cUTI except that caused by the pathogen K. pneumoniae. Further randomized controlled trials was still needed to evaluate tigecycline monotherapy for cUTI.

Introduction

It is well known that tigecycline, a novel glycylcycline antibiotic with potent antibacterial activity against most multidrug-resistant pathogens such as extended spectrum β-lactamase (ESBL) positive organisms, carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), has been approved for the treatment of skin infections, intra-abdominal infections and community-acquired bacterial pneumonia by the United States Food and Drug Administration (FDA), European Medicine Agency (EMA) and National Medical Products Administration (NMPA).[1–3]

With increasing bacterial resistance, antibiotic options for treatment of complicated urinary tract infection (cUTI) caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) organisms are often limited for clinicians. Colistin and aminoglycosides are potential therapeutic options for untreatable gram-negative infections, however, both of those drugs are highly nephrotoxic agents, and acute kidney injury occurs frequently with conventional doses, especially in severe cUTI patients.[4]

Although tigecycline is not considered as a valid option for cUTI because of its low serum concentration and limited excretion into urine (33% of the total dose is excreted as unchanged tigecycline in urine),[5] several successful cases for the treatment of multidrug-resistant cUTI by tigecycline has been reported in recent years representing tigecycline, as the last-resort drug, become the less toxic option for patients with renal disease.[6,7] However, the outcomes of these reports have not been completely consistent. Results of a retrospective cohort study showed no statistically significant differences in microbiologic clearance rates between tigecycline group and untreated group.[8] It is hard to demonstrate that tigecycline is as effective in cUTI as in other infections. We therefore summarized and analyzed articles of cUTI patients who were treated with tigecycline to evaluate the efficacy and safety of tigecycline therapy. We present the following article in accordance with the PRISMA reporting checklist (available at http://dx.doi.org/10.21037/tau-20-959).

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