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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 5, issue 2
J. Bone Joint Infect., 5, 60–66, 2020
https://doi.org/10.7150/jbji.42448
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 5, 60–66, 2020
https://doi.org/10.7150/jbji.42448
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 21 Feb 2020

Original full-length article | 21 Feb 2020

Tigecycline Versus Colistin in the Treatment of Carbapenem-resistant Acinetobacter baumannii Complex Osteomyelitis

Priscila R. Oliveira1, Vladimir C. Carvalho1, Eduardo S. Saconi1, Marcos C. Leonhardt1, Kodi E. Kojima1, Jorge S. Santos1, Flavia Rossi2, and Ana Lucia L.M.1 Priscila R. Oliveira et al.
  • 1Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil;
  • 2Laboratorio de Microbiologia DLC, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil

Keywords: Acinetobacter, carbapenem-resistant, colistin, osteomyelitis, tigecycline

Abstract. Background: Acinetobacter baumannii complex is an increasingly important cause of osteomyelitis. It is considered a difficult to treat agent, due to increasing antimicrobial resistance and few available therapeutic options.

Objective: To compare effectiveness and tolerability of tigecycline and colistin in patients with osteomyelitis caused by carbapenem-resistant A. baumannii complex (CRABC).

Methods: This retrospective review included all patients admitted to a 150-bed tertiary hospital from 2007 to 2015 with microbiologically confirmed CRABC osteomyelitis for which they received tigecycline or colistin. Data on demographic and clinical characteristics, adverse events, and outcomes 12 months after the end of antimicrobial treatment were analysed and stratified according to the antimicrobial used.

Results: 65 patients were included, 34 treated with colistin and 31 with tigecycline. There were significantly more men (P = 0.028) in the colistin group, and more smokers (P = 0.021) and greater occurrence of chronic osteomyelitis (P = 0.036) in the tigecycline treatment group. Median duration of therapy was 42.5 days for colistin and 42 days for tigecycline, with no significant difference. Overall incidence of adverse events was higher in the colistin group (P = 0.047). In particular, incidence of renal impairment was also higher in this group (P = 0.003). Nausea and vomiting were more frequent with tigecycline (P = 0.046). There were no significant differences between groups in relapse, amputation, or death.

Conclusions: Tigecycline had a better safety profile than colistin in the treatment of osteomyelitis due to CRABC, with no significant difference in outcomes after 12 months of follow-up.

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