P01 A review of tigecycline use in a large teaching hospital trust
Authors: Atack Kelly 
Published: January 2023

Background

Tigecycline is licensed for use in complicated intra-abdominal and complicated skin and soft tissue infections and is listed in seven guidelines at our large teaching hospital trust. Tigecycline is also used when advised by microbiology or infectious diseases. A drug safety update was published by the Medicines and Healthcare products Regulatory Agency (MHRA) in 2011 warning of increased mortality in clinical trials when tigecycline was used compared with other antibiotics. A review was undertaken to identify whether tigecycline was being used appropriately across a year period.

Methods

Tigecycline is kept as stock on some wards and dispensed individually to patients where stock is not kept. Dispensing data between April 2021 and March 2022 was reviewed. 409 vials were dispensed as stock and 64 patients had tigecycline dispensed directly to them.

Results

18 patients (28%) had tigecycline prescribed as per guidelines, 51 (75%) patients had tigecycline prescribed on the advice of microbiology and out of the 25% patients who did not have microbiology involvement, three patients did not have a clear indication for tigecycline use, with no positive microbiology. 9 patients (14%) had tigecycline prescribed as per oesophageal bleed prophylaxis guidelines and one patient for allergy testing purposes. 24 patients (38%) were prescribed tigecycline for licensed indications, with one patient being prescribed it for cellulitis and the rest for complicated intra-abdominal infections. Examples of other indications where tigecycline was used were bacteraemias, pelvic infections, bone and joint infections and line infections. 41 patients (64%) had positive microbiology samples and all of these patients were discussed with microbiology. Most patients had grown vancomycin-resistant enterococci or Enterococcus faecium. See Figure 1 for the range of microbiology sampled. The MHRA update in 2011 advised of an increased mortality rate of 2.3% (52/2216) when using tigecycline for complicated skin and soft tissue and complicated intra-abdominal infections compared with 1.5% (33/2206) in clinical trials, so mortality data was considered as part of this review. 11 patients (17%) of patients died within 28 days of receiving tigecycline. For 5 of these patients, infection was listed on their death certificate, 2 patients did not have infection listed, 1 patient is awaiting an inquest and 3 patients did not have a death certificate listed on their hospital record due to place of death being outside the hospital.

Conclusions

It is reassuring that most of the tigecycline prescribed is within guidelines or has been discussed with microbiology and use is based on positive samples, with only 3 patients (5%) having no clear reason why tigecycline was prescribed. A limitation of this review was that some patients who received tigecycline across the year period could not be identified using dispensing data only. A future review would be beneficial to examine all the prescribing data from the electronic medicines system and continued monitoring of use and mortality.