Antibiotic optimization in the difficult-to-treat patient with complicated intra-abdominal or complicated skin and skin structure infections: focus on tigecycline

Figures & data

Table 1 Common isolates from intra-abdominal infections

Primary peritonitis	Usually monomicrobial	Enterobacteria
		Staphylococci
		Streptococci
Secondary peritonitis	Usually polymicrobial	Nonanaerobes
		Enterobacter species
		Enterococci
		Escherichia coli
		Klebsiella species
		Proteus species
		Pseudomonas aeruginosa
		Staphylococci
		Streptococci
		Anaerobes
		Bacteroides species
		Clostridium species
		Fusobacterium species
		Peptostreptococcus species
		Candida species
Tertiary peritonitis	Depends on cause	Enterococci
		Pseudomonas aeruginosa
		Staphylococci
		Candida species

Table 2 Most common bacterial isolates from cSSSIs

CA-cSSSIs	HA-cSSSIs
Staphylococcus aureus	Staphylococcus aureus
Streptococcus pyogenes	Pseudomonas aeruginosa
Enterococcus species	Enterococcus species
	Escherichia coli

Abbreviations: cSSSIs, complicated skin and skin structure infections; CA-cSSSIs, community acquired–complicated skin and skin structure infections; HA-cSSSIs, hospital acquired–complicated skin and skin structure infections.

Table 3 Antimicrobial agents that are not effective against resistant organisms

MRSA
CA	β-lactam drugs
HA	β-lactam drugs
	Aminoglycosides
	Fluoroquinolones
	Oxazolidinones
	Streptogamins
	Tetracycline
	Trimethoprim-sulfamethoxazole
	Vancomycin – beginning
VRE	Vancomycin
	associated with ampicillin resistance
	Aminoglycosides
	Clindamycin
	Erythromycin
	Tetracycline
	Trimethoprim-sulfamethoxazole
	facilitate colonization
	Aminoglycosides
	Extended-spectrum cephalosporins
	Fluoroquinolones
ESBLs	Aminoglycosides
	β-lactam drugs, including third-generation cephalosporins, monobactams, and sometimes carbapenems (KPCs)
	Sulfonamides
Anaerobes	β-lactam drugs – most increasing resistance to cephalosporins
	Chloramphenicol – some strains
	Clindamycin – low to moderate resistance
	Metronidazole – in the Gram-positives
	Quinolones – low to moderate resistance
	Tetracycline – most B. fragilis strains, also found in C. perfringens

Abbreviations: MRSA, methicillin-resistant S. aureus; CA, community-acquired; HA, hospital-acquired; VRE, vancomycin-resistant enterococci; ESBLs, extended-spectrum β-lactamases; KPCs, K. pneumoniae carbapenemases.

Table 4 Organisms against which tigecycline demonstrated favorable bacteriostatic activity

Gram-positive

Corynebacterium jeikeium

Enterococcus species – including VRE

Listeria monocytogenes

Staphylococcus species – including MRSA

Streptococcus species

Gram-negative

Enterobacteriaceae – including ESBLs, KPCs, and other β-lactamases

Citrobacter species

Enterobacter species

Escherichia coli

Klebsiella species

Salmonella species

Serratia marcescens

Shigella species

Non-Enterobacteriaceae

Acinetobacter species

Haemophilus influenzae

Moraxella species

Neisseria species

Stenotrophomonas maltophilia

Anaerobes

Bacteroides species

Clostridium difficile

Clostridium perfringens

Fusobacterium species

Peptostreptococcus species

Porphyromonas species

Prevotella species

Propionibacterium acnes

Atypical

Chlamydophila pneumoniae

Mycoplasma species

Abbreviations: VRE, vancomycin-resistant enterococci; MRSA, methicillin-resistant S. aureus; ESBLs, extended-spectrum β-lactamases; KPCs, K pneumoniae carbapenemases.