787. Tigecycline Use for Clostridium difficile infections, a single center experience
Session: Poster Abstract Session: Antimicrobials: Treatment of HAI and Resistant Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDWeek tigecycline use for C.diff infections.pdf (441.5 kB)
  • Background:

    Clostridium difficile infections (CDI) are one of most common nosocomial infections. Current SHEA/IDSA guidelines recommend treatment strategies based on severity of disease. In 2011, the Hospital of Saint Raphael adapted a new guide for providers largely based on the recommendations from the aforementioned guideline, adding the use of tigecycline in cases with severe complications.  The intention of the study is to describe our experience and outcomes using tigecycline in patients with severe CDI.

     Methods:

    Retrospective chart review of adult patients diagnosed and treated for Clostridium difficile infection at the Hospital of Saint Raphael in 2012 that received additional treatment with tigecycline.

    Results:

    Twelve patients were identified during the study period. The mean age was 72 years, 58% were men and 67% were residents at a skilled nursing facility (SNF); 75 % had been hospitalized in the previous 3 months, with a mean of 2.9 admissions. Seventy five percent of patients were dependent for ADLs and all of them had at least one risk factor for CDI (100% had prior exposure to antibiotics, 75% on acid suppressive therapy, 66.7% on narcotics). Mean Charlson score was 8.2.

    Fever was present in 41.7% of the cases; an abnormal abdominal exam was reported in the majority of patients.

    Mean WBC count was 21,500; bandemia was present in 75% of the patients (Mean-16% bands). CDI was severe complicated in 11 of the 12 cases.

    Initial empiric therapy was adequate (based on choice and dosage of antibiotics) in 50% of the patients. Tigecycline was used as adjunctive therapy in all of the patients with a mean duration of 8.0 days.

    The inpatient mortality was 25% and in the 9 patients that were discharged, hospice care was established for 3 patients all of whom had died within 1 month. Of the 6 patients discharged to either home or SNF, 3 were readmitted within 30 days.

    Conclusion:

    The use of Tigecycline in severe, complicated CDI is based on case reports rather than evidence-based. Our experience suggests that despite anecdotal reports of improvement with Tigecycline in these patients, their morbidity and mortality remains high. Further studies will be needed to assess its real impact on outcomes when compared with standard therapy.

    Odaliz Abreu Lanfranco, MD1, Merilda Blanco Guzman, MD1, Marjorie Golden, MD1, Ann Fisher, MD1,2 and Whitney (Yu-Hui) Hung, PharmD, BCPS (AQ-ID)3, (1)Department of Medicine, Yale New Haven Hospital, New Haven, CT, (2)Yale University School of Medicine, New Haven, CT, (3)Pharmacy, Yale New Haven Hospital, New Haven, CT

    Disclosures:

    O. Abreu Lanfranco, None

    M. Blanco Guzman, None

    M. Golden, None

    A. Fisher, None

    W. Hung, None

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