The Spectrum of Tigecycline-Induced Pancreatitis in Clinical Characteristics, Diagnosis, and Management

Figures & data

Table 1 Characteristics of Included Patients with Tigecycline-Induced Pancreatitis

Parameter		Value
Sex^b,Citation34	Male	20(58.8%)
	Female	13(38.2%)
	No data	1(2.9%)
Age^b,Citation34	Years	50(9,87)^a
	≥60 years	10(29.4%)
Region^b,Citation34	China	18(52.9%)
	The United States	6(17.6%)
	France	4(11.8%)
	Belgium	2(5.9%)
	Turkey	1(2.9%)
	Italy	1(2.9%)
	Spain	1(2.9%)
	Egypt	1(2.9%)
Indication for tigecycline^b,Citation34	Pulmonary infection	7(20.6%)
	Prophylaxis after transplantation	6(17.6%)
	Osteomyelitis	5(14.7%)
	cSSSI	5(14.7%)
	BSI	3(8.8%)
	Donor-derived infection after kidney transplantation	3(8.8%)
	IAI	2(5.9%)
	Urinary tract infection	2(5.9%)
	Perianal abscess	1(2.9%)
Risk factors for acute pancreatitis^b,Citation34	Gallstones, alcohol, smoking, hypertriglyceridemia	1(2.9%)
Bacteriumb^,Citation26	Acinetobacter baumannii (MDR)	5(19.2%)
	Mixed bacterial	5(19.2%)
	Escherichia coli (ESBL)	4(15.4%)
	Enterobacter cloacae (ESBL)	2(7.7%)
	Carbapenem-resistant Klebsiella pneumonia (CRKP)	2(7.7%)
	Mycoplasma chelonae	2(7.7%)
	G^+ bacteria	2(7.7%)
	Klebsiella pneumoniae (ESBL)	1(3.8%)
	Pseudomonas aeruginosa	1(3.8%)
	MRSA	1(3.8%)
	MSSA	1(3.8%)
Accompanying diseases^b,Citation32	Kidney transplantation	13(40.6%)
	Malignant tumor	4(12.5%)
	Hypertension	7(21.9%)
	Nephritis or renal insufficiency	4(12.5%)
	Diabetes mellitus	3(9.4%)
	Sickle-cell anemia	2(6.2%)
	Lung transplantation	1(3.1%)
	Liver transplantation	1(3.1%)
Loading dose of tigecycline used^b,Citation28	YES	18(64.3%)
	NO	10(35.7%)
Maintenance dose of tigecycline^b,Citation28	50 mg ivgtt q12h	25(89.3%)
	100 mg ivgtt q12h	3(10.7%)
Concomitant medication^b,Citation34	Antibacterials	25(73.5%)
	Immunosuppression	15(44.1%)
	Corticosteroids	14(41.2%)
	Antifungal drugs	9(26.5%)
	Anti-CD25 monoclonal	5(14.7%)
	Hydroxyurea	2(5.9%)
	Cyclophosphamide	1(2.9%)
	Propofol	1(2.9%)
Time of symptom onset during the first tigecycline administration^b,Citation34	Days	7(2,29)^a
	Symptom onset within 1 week	18(52.9%)
	Symptom onset 1–2 weeks	13(38.2%)
Pancreatitis occurs in two consecutive tigecycline administrations^b,Citation4	Days	8(3,29)^a
	The secondary occurred within 1 week	2(50.0%)

Notes: ^aMedian (minimum-maximum). ^bRepresents the number of patients among a total of 34 on whom information regarding this particular parameter was provided.

Abbreviations: cSSSI, complicated skin and skin-structure infection; BSI, blood stream infection; IAI, intra-abdominal infection; ESBL, extended-spectrum betalactamase; MDR, multidrug-resistant; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin sensitive Staphylococcus aureus.

Table 2 Comparison of Clinical Characteristics of Included Patients with or Without Solid Organ Transplantation

Variable	Non-Transplant Patients (n=19)*	Transplant Patients (n=15)	P value
Male	10	10	0.63
Female	8	5	0.63
Age (Years)	57.5(9,87)^a	44(12.5,61)^a	0.03
AP severity (Moderate/Severe)	17/2	14/1	0.86
Time of symptom onset during the first tigecycline administration (Days)	10(2,29)^a	7(3,28)^a	0.68
The peak of Amylase (U/L)	381(180,1250)^a	632(157,1250.8)^a	0.17
The peak of Lipase (U/L)	814(134,4089)^a	682(156,1835)^a	0.91
Time to symptom relief (Days)	3(1,12)^a	4.5(1,7)^a	0.61
Time to recovery of enzymes (Days)	5(1,43)^a	5(2,14)^a	0.52

Notes: ^aMedian (minimum-maximum). *One patient in this group did not provide gender.

Table 3 Clinical Information on the 34 Included Patients

Parameter	Clinical Features	Value, n (%)
Presenting symptoms^b,Citation32	Abdominal pain	29(90.6%)
	Nausea	15(46.9%)
	Vomiting	14(43.8%)
	Abdominal distension	7(21.9%)
AP severity^b,Citation34	Moderate	31(91.2%)
	Severe	3(8.8%)
Imaging examination	CT scan	28
	Oedematous infiltrate	16(57.1%)
	Acute pancreatitis	9(32.1%)
	Normal	3(10.7%)
	Ultrasonogram of the abdomen	3
	Pancreatic oedema	2(66.6%)
	Normal	1(33.3%)
Amylase^b,Citation25	U//L	570.5(157,1250.8)^a
Lipase^b,Citation26	U//L	740.5(134,4089)^a
Therapy^b,Citation34	Discontinued tigecycline	33(97.0%)
	Continued tigecycline	1(2.9%)
	Fasting treatment	14(41.2%)
	Inhibition of pancreatic enzyme secretion	12(35.3%)
	Proton pump inhibitor	8(23.5%)
	Drainage tube	2(5.9%)
	Emergency laparotomy	1(2.9%)
Time to symptom relief^b,Citation27	Days	4(1,12)
	Within 4 days	7(25.9%)
	Within 1 week	25(92.6%)
Time to recovery of enzymes^b,Citation27	Days	5(1,43)
	Within 4 days	15(55.5%)
	Within 1 week	20(74.1%)
Naranjo score^b,Citation34	Possible	6(17.6%)
	Probable	24(70.6%)
	Definite	4(11.8%)

Notes: ^aMedian (minimum-maximum). ^bRepresents the number of patients among a total of 34 on whom information regarding this particular parameter was provided.

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