Clinical experience in 52 patients with tigecycline-containing regimens for salvage treatment of Mycobacterium abscessus and Mycobacterium chelonae infections

• Published in: Journal of antimicrobial chemotherapy Vol. 69; no. 7; pp. 1945 - 1953
• Main Authors: Wallace, R. J., Dukart, G., Brown-Elliott, B. A., Griffith, D. E., Scerpella, E. G., Marshall, B.
• Format: Journal Article
• Language: English
• Published: England Oxford Publishing Limited (England) 01.07.2014; Oxford University Press
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antitubercular Agents - adverse effects; Antitubercular Agents - therapeutic use; Bacterial infections; Child; Cystic fibrosis; Drug Therapy, Combination - methods; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - pathology; Female; Humans; Male; Medical treatment; Middle Aged; Minocycline - adverse effects; Minocycline - analogs & derivatives; Minocycline - therapeutic use; Mycobacterium Infections, Nontuberculous - drug therapy; Mycobacterium Infections, Nontuberculous - microbiology; Nausea - chemically induced; Nausea - epidemiology; Nontuberculous Mycobacteria - isolation & purification; Original Research; Pulmonary fibrosis; Salvage Therapy - adverse effects; Salvage Therapy - methods; Treatment Outcome; Young Adult; non-tuberculous mycobacteria; pulmonary; atypical mycobacterial infections; cystic fibrosis
• ISSN: 0305-7453; 1460-2091; 1460-2091
• DOI: 10.1093/jac/dku062

We report the largest clinical experience using tigecycline-containing regimens for salvage treatment of patients with Mycobacterium abscessus and Mycobacterium chelonae. Data were collected from 52 patients on emergency/compassionate use (n = 38) or two open-label studies (n = 7 patients each). Based on information that was available, 46 (88.5%) of the subjects received antibiotic therapy prior to treatment with tigecycline. Treatment groups were evaluated based on length of tigecycline therapy (<1 and ≥1 month). ClinicalTrials.gov identifiers: Study 205, NCT00600600 and Study 310, NCT00205816. The most commonly used concomitant antimicrobials were macrolides, amikacin and linezolid. Pulmonary disease was the most common presentation (36/52; 69.2%), and 58.3% of these patients had underlying cystic fibrosis. The majority were M. abscessus complex (n = 30) or M. chelonae/abscessus (n = 4). With therapy ≥1 month (mean, 255.0 ± 265.7 days), 10/15 patients (66.7%) with cystic fibrosis and 16/26 (61.5%) overall were considered improved. Skin/soft-tissue/bone infections were the most common extrapulmonary infections. With therapy ≥1 month (mean, 143 ± 123 days), 9/12 patients (75.0%) were considered improved. Nine of the 16 cases reported as failures regardless of site of infection occurred in patients who stopped treatment due to adverse events. There were eight deaths; none was related to tigecycline. Tigecycline given for ≥1 month as part of a multidrug regimen resulted in improvement in >60% of patients with M. abscessus and M. chelonae infections, including those with underlying cystic fibrosis, despite failure of prior antibiotic therapy. Adverse events were reported in >90% of cases, the most common being nausea and vomiting.