A Questionnaire-based Survey to Understand the Practice Patterns about the Use of Tigecycline IV in Indian ICUs

INTRODUCTION: Tigecycline, a glycylcycline-class antibiotic, exhibits a broad-spectrum activity against multidrug-resistant (MDR) infections, targeting Gram-positive and Gram-negative bacteria.(1) Tigecycline has demonstrated good in vitro activity against Acinetobacter spp., extended-spectrum beta-lactamase (ESBL) producers, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE). OBJECTIVES: To understand the practice patterns of the use of tigecycline intravenous (IV) in Indian ICUs (Intensive Care Units) among clinicians across India. MATERIALS AND METHODS: A questionnaire-based survey was conducted among critical care specialists in India. The digital questionnaire, consisting of 16 questions, evaluated the practice patterns regarding antibiotic use in the treatment of complicated skin and skin structure infections (cSSSI) and complicated intra-abdominal infections (cIAI) caused by MDR bacteria. Data from completed questionnaires were retrieved and analyzed. RESULTS: A total of 85 clinicians from India participated in the survey. The majority of clinicians 52.94% reported that the prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) in ICU patients was 20–40%. Around 46.00% of clinicians reported a similar prevalence for carbapenem-resistant Enterobacteriaceae (CRE). Approximately 55.00% of clinicians stated that the prevalence of MRSA in patients with cSSSI was 20–40%. The majority of clinicians used tigecycline IV for cIAI and cSSSI treatment (83.53% and 81.18%, respectively). The majority of clinicians (80.00%) considered tigecycline IV as empirical therapy for cIAI, followed by cSSSI (55.29%). Additionally, 54.12% of clinicians recommended tigecycline IV for CRE, 49.41% for CRAB, 35.29% for MRSA, and 20.00% for VRE. About 45.00% and 20.00% of clinicians recommended a tigecycline dose of 100 mg IV followed by 50 mg IV twice a day (BD) in cSSSI and cIAI, respectively. In clinical practice, the average duration of tigecycline IV treatment varied, with approximately 40.00% of clinicians preferring a 7-day regimen, 21.18% recommending 5-7 days, and 31.00% opting for up to 14 days. Around 44.00% and 18.00% of clinicians recommended a long duration of treatment (≥14 days) with tigecycline IV for cIAIs and cSSSI, respectively. Most clinicians 61.18% preferred combining colistin with tigecycline IV for treating CRE infections, followed by polymyxin B 58.82% and fosfomycin 16.47%. Around 58.00% of clinicians preferred combining colistin with tigecycline IV for treating CRAB infections, followed by Polymyxin B 56.47% and Sulbactam 31.76%. Nausea 32.94% and diarrhea 16.47% were the most reported mild and moderate side effects associated with tigecycline IV. Approximately 34.00% of clinicians rated the efficacy of tigecycline IV as 8 on a 0-10 scale while 17.65% rated it as 7, 9, or 10 with 10 indicating highly effective. Approximately 25.00% of clinicians rated tigecycline safety as 8, while 27.00% rated it as 9, and 25.88% rated it as 10 with 10 indicating safer. CONCLUSION: Clinicians recommended Tigecycline IV in the treatment of cIAIs and cSSSI caused by CRE/CRAB and was reported to be effective and well-tolerated.