Tigecycline treatment experience against multidrug-resistant Acinetobacter baumannii infections: a systematic review and meta-analysis

• Systematic review and meta-analysis to evaluate the efficacy and safety of tigecycline for the treatment of multidrug-resistant Acinetobacter baumannii.
• No significant difference was noted when tigecycline was compared with control groups in terms of all-cause mortality and clinical response.
• Subgroup analysis found tigecycline was associated with higher in-hospital mortality, lower microbial eradication rate and a trend for longer hospital stay.
• High resistance and superinfection rates were observed during tigecycline treatment.

The role of tigecycline in treating multidrug-resistant Acinetobacter baumannii (MDR-AB) infections remains controversial. A systematic review and meta-analysis was performed to assess the efficacy and safety of tigecycline in treating MDR-AB infections. PubMed, Embase and Cochrane Library databases were searched up to 20 September 2015. Studies evaluating the efficacy and/or safety of tigecycline in treating MDR-AB infections were included. PRISMA guidelines were followed and the I2 method was used for heterogeneity. Seven controlled and seventeen single-arm studies were included. No significant difference was noted when tigecycline was compared with control groups in terms of all-cause mortality (OR = 0.87, 95% CI 0.50–1.52; P = 0.63) and clinical response (OR = 1.58, 95% CI 0.61–4.05; P = 0.34). Subgroup analysis indicated that treatment with tigecycline was associated with higher in-hospital mortality (OR = 1.57, 95% CI 1.04–2.35; P = 0.03). Compared with controls, tigecycline had a significantly lower microbial eradication rate (OR = 0.20, 95% CI 0.07–0.59; P = 0.003) and trend for longer hospital stay (mean difference, 4.69 days, 95% CI −0.17 to 9.55 days; P = 0.06). In comparison with monotherapy, tigecycline combination therapy did not affect mortality, clinical response or microbiological response. Tigecycline was well tolerated in the patient populations studied. The pooled rates of resistance emergence and superinfection during treatment were 12.47% and 19.11%, respectively. These findings disfavour the use of a tigecycline-based regimen for the treatment of MDR-AB infections. Well-designed RCTs are needed to clarify the role of tigecycline for MDR-AB infections.