Email updates

Keep up to date with the latest news and content from Critical Care and BioMed Central.

This article is part of the supplement: 27th International Symposium on Intensive Care and Emergency Medicine

Poster presentation

Hypercalcaemia resulting from the use of tigecycline in the treatment of multidrug-resistant Acinetobacter in patients with multiorgan failure

M Duffy, M Thomas, G Auzinger, W Bernal, E Sizer and J Wendon

Author Affiliations

Institute of Liver Studies, London, UK

For all author emails, please log on.

Critical Care 2007, 11(Suppl 2):P100  doi:10.1186/cc5260


The electronic version of this article is the complete one and can be found online at:


Published:22 March 2007

© 2007 BioMed Central Ltd.

Introduction

Tigecycline (Wyeth) is a new glycylcycline antimicrobial that has been used in the treatment of deep-seated multidrug-resistant Acinetobacter (MDRA) infections. Unexpected changes in routine hematology or serum chemistry have not been reported.

Methods

All patients were managed within the liver ICU and received standard care. Laboratory data were collected daily and entered onto a specialist database. MDRA-positive cultures from blood, bronchoalveolar lavage, drain fluid or samples taken at laparotomy in the context of systemic inflammatory response syndrome resulted in the initiation of tigecycline 100 mg i.v. followed by 50 mg i.v. 12 hourly.

Results

Eleven patients received tigecycline treatment for MDRA infections (seven male). Ten patients had a single course whilst one patient had three courses. Underlying disease states were necrotising pancreatitis (one), polytrauma (one), post hepatectomy (one), acute and acute on chronic liver failure (four), and post-orthotopic liver transplant (four). The median duration of treatment was 9 days (range 4–23 days); courses <7 days were because of patient death (2/11). The mean APACHE II score at initiation of therapy was 18 (range 13–26). Four out of 11 survived to ICU discharge and 3/11 to hospital discharge. Tigecycline was well tolerated but increases in corrected calcium were observed in 9/11 patients. The patient that received three courses of treatment had elevations in corrected calcium after each course. For the 11 patients, the mean corrected calcium before treatment with tigecycline was 2.41 mmol/l. The mean corrected calcium on finishing the course increased to 2.59 mmol/l (P = 0.012). There was no correlation between duration of treatment with tigecycline and degree of change in the corrected calcium level (r = 0.08). Hypercalcaemia resolved on discontinuation of the drug; 7/11 survived >7 days after treatment and had a mean corrected calcium of 2.46 mmol/l, which was not significantly different from pretreatment levels (P = 0.94).

Conclusion

Tigecycline is well tolerated but appears to be associated with an elevated corrected calcium in critically ill patients. This returns to baseline values on discontinuation of the drug.