Stenotrophomonas maltophilia as the cause of ventilator-associated pneumonia in a female patient with toxic epidermal necrolysis and Clostridium colitis: time for off-label tigecycline?

Česká verzia

Authors: B. Lipový ^1,2; H. Řihová ¹; M. Hanslianová ³; I. Suchánek ¹; P. Brychta ^1,2
Authors place of work: Klinika popálenin a rekonstrukční chirurgie FN Brno ¹; Lékařská fakulta Masarykovy univerzity Brno ²; Oddělení klinické mikrobiologie, FN Brno ³
Published in the journal: Epidemiol. Mikrobiol. Imunol. 65, 2016, č. 3, s. 177-181
Category: Původní práce

Summary

Toxic epidermal necrolysis (TEN) is an autoimmune disease which is usually caused by a reaction to drugs. It affects mainly the skin and mucous membranes. It is a rare condition with a high mortality rate. Fatal outcomes in patients with TEN are mostly due to infectious complications. As antimicrobial drugs may induce this syndrome, the management of this condition is very complicated. Tigecycline is still a relatively new antibiotic approved in Europe for use in complicated intra-abdominal infections and complicated skin and soft tissue infections. Among major advantages of tigecycline in patients with TEN are its good penetrability into tissues, wide spectrum of activity that makes it suitable for use as monotherapy, and last but not least, in comparison with other antimicrobials, a very low potential for exacerbation of the severity of the underlying disease by further stimulation of the immune system. A case report is presented of a successful management of an 81-year-old woman with TEN and multiple infectious complications in different anatomic locations, the most serious of which was ventilator-associated pneumonia caused by Stenotrophomonas maltophilia. Her general condition was further aggravated by Clostridium colitis. Tigecycline was used as the therapeutic option for ventilator-associated pneumonia, although prescribed off-label.

Key words:
toxic epidermal necrolysis – tigecycline – off-label indications – Clostridium colitis

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