Clinical outcomes and their relationship with tigecycline exposure in critically ill patients with drug resistant infections
In brief
Higher tigecycline exposure linked to lower response; half of patients responded
In this single-center study of 130 critically ill patients with drug-resistant infections, half had a clinical response and 36.2% died within 28 days. Higher tigecycline exposure was associated with lower odds of response, but the observational design cannot show that exposure caused poorer outcomes. The unexpected finding underscores how little is known about the best dosing targets in these patients.
- Journal
- Frontiers in cellular and infection microbiology (Q1)
- Published
- 16 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Wei Su, Shuping Song, Qing Tang, Binbin Feng, Yinshan Wu, Haitao Yu, et al.
- PMID
- 42819136
- DOI
- 10.3389/fcimb.2026.1868760
Why clinicians should know about it
- Picked for Pharmacology (medical) (paper of the day, 4 October 2026): Tigecycline exposure‑outcome relationship in ICU patients
Abstract
BACKGROUND: Dosing tigecycline, an important last resort for carbapenem-resistant organisms, should be under the guidance of pharmacokinetic/pharmacodynamic (PK/PD) theory. However, tigecycline has shown large interindividual variability in PK among different patients, and its PK/PD target has limited data support. This study aimed to evaluate the clinical outcome and the relationship with exposure in critically ill patients with drug-resistant infections. METHODS: A single center, prospective observational, single-arm cohort study was performed to assess the outcome and its relationship with exposure in critically ill patients with drug-resistant pathogen infections. Patients were enrolled according to the inclusion and exclusion criteria. The clinical outcomes, including clinical response rate, 28-day mortality rate, and major adverse events (AEs), were followed up. Plasma concentrations in steady status were intensively collected and determined for tigecycline concentration, and the 24-hour area-under-curves (AUCs) were calculated. The exposure-clinical outcome relationship was analyzed, and multivariate logistic regressions were performed to identify risk factors that associated with outcome. RESULTS: A total of 130 patients were included. The most common infection type was low respiratory tract infection (76/130), and carbapenem-resistant Acinetobacter baumannii was the most common pathogen (64/130). The median tigecycline treatment length was 12 days. The median AUC was 14.0 mg h/L. The overall response rate and 28-day mortality rate were 50.0% and 36.2%, respectively. A lower fibrinogen level was the most common AE (51/130). ALB, PLT and combined use of cefoperazone-sulbactam were independent factors associated with clinical response, but AUC was negatively associated with clinical response. CONCLUSION: The clinical outcome of tigecycline in critically ill patients with resistant pathogen infection was satisfactory, but negative relationship between tigecycline exposure and outcome was found and the PK/PD profile in these patients should be revisited.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.