40196. Multidrug Resistant (MDR) Acinetobacter calcoaceticus-baumanii (ACB) complex Prosthetic Joint Infection (PJI) Successfully Treated with Debridement, Implant Retention, and High-Dose Tigecycline: Report of 3 Cases
Session: Poster Abstract Session: Medical Student Poster Session
Friday, October 4, 2013
Room: Yerba Buena Ballrooms
Posters
  • 40196_IDWPOSTER.pdf (298.7 kB)
  • Background: Fluorquinolone-resistant gram-negative bacilli (GNB) PJIs are associated with high failure rates when retention of the prosthesis is attempted, even with aggressive antibiotic therapy. MDR ACB complex is considered a relative contraindication to debridement and implant retention (DAIR) strategies. Tigecycline has anti-biofilm activity and good bone penetration, nevertheless is not approved for treating neither PIJs nor MDR ACB complex infections. Considering that the area under the curve divided by the MIC (AUC/MIC) is most likely to be the best pharmacokinetic predictor of efficacy of tigecycline, we used this agent at higher doses than the recommended in order to achieve implant retention.

    Methods: All patients with PJIs treated at our institution are prospectively registered in a database. Cases of MDR ACB complex treated with DAIR and high doses of tigecycline were retrospectively reviewed. All patients signed informed consent to receive this off-label use of tigecycline. At least 4 intraoperative periprosthetic tissue samples were taken with separate instruments for culture and histology. Two females and 1 male with early PJI of THA due to MDR ACB complex (susceptible only to colistin, tigecycline and minocycline) were treated with DAIR and high doses of tigecycline (100 mg/12 h). Average patient’s age was 58 years (range 45-75). Because of its ease of administration and good safety profile most of the treatment was administered as outpatient parenteral therapy.

    Results: Tigecycline was well tolerated allowing its administration at the mentioned doses for a median of 40 days (range 30-60) and then switched to minocycline at standard doses for a media of 3,3 months (range 0-7). An average of 9,3 months (range 6-13) after therapy discontinuation none of them has relapsed. The three patients are asymptomatic with functional THA.

    Conclusion: Tigecycline is probably under dosed for the treatment of PJIs due to ACB complex. Higher doses (≥ 100mg/12 h) may be required to achieve clinical success. DAIR combined with high doses of tigecycline may be an effective treatment for PJIs due to MDR ACB complex. Although this approach might be promising this off-label use of tigecycline should be interpreted cautiously and more prospective data are warranted.

    Andrea Vila, MD1, Claudio Amadio, MD1, Hugo Pagella, PhD2 and Alejandro Leiva, MD2, (1)Infectious Diseases, Hospital Italiano De Mendoza, Mendoza, Argentina, (2)Hospital Italiano De Mendoza, Mendoza, Argentina

    Disclosures:

    A. Vila, None

    C. Amadio, None

    H. Pagella, None

    A. Leiva, None

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