788. Impact of tigecycline as adjunctive therapy for severe, complicated Clostridium difficile infection
Session: Poster Abstract Session: Antimicrobials: Treatment of HAI and Resistant Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Impact of adjunctive Tigecycline on SC-CDI.pdf (408.8 kB)
  • Background: For patients deemed not to be candidates for colectomy, optimal antimicrobial therapy for severe, complicated C. difficile infection (SC-CDI) is not well-studied. Tigecycline has excellent in vitro activity against C. difficile and inhibits the synthesis of bacterial proteins including toxins, suggesting a potential role in SC-CDI management. We investigated the effectiveness of tigecycline in reducing in-hospital mortality in patients with SC-CDI who were not surgical candidates.

    Methods: A retrospective case-control study was performed among patients diagnosed with SC-CDI by positive toxin EIA or DNA amplification assay during the period 9/2009 through 6/2012. Cases were defined as patients receiving adjunctive tigecycline plus standard C. difficile agents (vancomycin orally and/or rectally and metronidazole) and controls were defined as those receiving standard agents alone. The outcome was in-hospital mortality. Measurable confounding was addressed by including in the final logistic regression model a propensity score derived from variables determined a priori to be likely associated with the receipt of tigecycline. Propensity score and tigecycline were included in a final logistic regression model. All analyses were performed using SAS v.9.3.

    Results: Among 90 patients included in the analysis, 21 cases received adjunctive tigecycline and 69 controls received standard therapy. Patients receiving tigecycline were more likely to receive vancomycin rectally and intravenous immunoglobulin and have a concurrent intra-abdominal infection. The in-hospital mortality rate of tigecycline recipients was 3/21 (14%) compared to 16/69 (23%) in the standard treatment group (unadjusted OR 0.55 95% CI 0.14 – 2.12). Our propensity score model had a c statistic of 0.79. After adjusting for propensity score in the multivariable model, there was no significant difference in mortality between groups OR 0.71 (95% CI 0.16 – 3.24).

    Conclusion: In this largest single-center study to date, we did not demonstrate a significant difference in in-hospital mortality associated with the use of adjunctive tigecycline therapy in patients with SC-CDI who were not surgical candidates. Larger studies are required to determine the potential benefit of adjunctive tigecycline in CDI.

    Mary Lasalvia, MD1, Westyn Branch-Elliman, MD, MMSc2, Graham Snyder, MD1, Monica Golik Mahoney, PharmD, BCPS3, Carolyn D. Alonso, M.D.1, Howard Gold, MD1 and Sharon B. Wright, MD MPH1, (1)Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, (2)Divisions of Infectious Diseases and Infection Control, Beth Israel Deaconess Medical Center, Boston, MA, (3)Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA

    Disclosures:

    M. Lasalvia, None

    W. Branch-Elliman, None

    G. Snyder, None

    M. Golik Mahoney, Optimer Pharmaceuticals: Scientific Advisor, Consulting fee
    Cubist Pharmaceuticals: Consultant, Consulting fee

    C. D. Alonso, Cubist Pharmaceuticals: Investigator, Research support
    GSK: Investigator, Research support
    Sanofi Pasteur: Investigator, Research support

    H. Gold, None

    S. B. Wright, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.