High-Dose Tigecycline for Multidrug-Resistant Serratia Infections in Critically Ill Adults: A Systematic Review of Direct and Indirect Clinical Evidence.
- 1Department of Medicine, Command Hospital (Eastern Command), Kolkata, IND.
- 2Department of Critical Care Medicine, Command Hospital (Eastern Command), Kolkata, IND.
- 3Department of Gastroenterology and Hepatology, Command Hospital (Eastern Command), Kolkata, IND.
Abstract
Evidence for high-dose tigecycline in severe multidrug-resistant Gram-negative infections comes mainly from non-Serratia cohorts. Its value in critically ill adults with resistant Serratia infection is uncertain. PubMed/MEDLINE, CENTRAL, and Consensus were searched up to July 17, 2026. Two evidence sets addressed high-dose tigecycline effectiveness, pharmacokinetics, and safety, and clinical and microbiological evidence for resistant Serratia. Study-level risk ratios were presented without pooling. Searches identified 2,294 records, and 36 studies reported in 37 publications were included. No study reported a verified high-dose regimen in confirmed resistant Serratia infection with a separately extractable organism-specific outcome. Six observational studies used the same high-dose and standard-dose definitions. Fixed 28-day or 30-day mortality risk ratios ranged from 0.34 to 1.30, and all 95% confidence intervals crossed 1.0. Clinical response favored high dose in two studies, with risk ratios of 1.73 (95% confidence interval: 1.22-2.46) and 1.48 (95% confidence interval: 1.08-2.02). Microbiological response favored high dose in two studies, with risk ratios of 1.75 (95% confidence interval: 1.09-2.81) and 1.92 (95% confidence interval: 1.12-3.28). No pooled estimate was calculated. High dose produced a greater fibrinogen decline in one cohort (-3.05 ± 1.67 versus -1.75 ± 1.90 g/L; p=0.038) and more hepatic or platelet abnormalities in another. Direct evidence for high-dose tigecycline in resistant Serratia infection is absent. Indirect studies show possible response benefits without a consistent survival advantage. Treatment decisions should consider infection site, susceptibility, active alternatives, and coagulation risk. By synthesizing both pathogen-specific studies and relevant indirect clinical evidence, this review aimed to provide a more comprehensive assessment of the potential role of high-dose tigecycline in critically ill adults with resistant S. marcescens infections.
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BibTeX
@article{choudhury2026highdose,
title = {{High-Dose Tigecycline for Multidrug-Resistant Serratia Infections in Critically Ill Adults: A Systematic Review of Direct and Indirect Clinical Evidence.}},
author = {Arnab Choudhury and Ashutosh Chaturvedi and Adil Ashraf and K V Padmaprakash},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116890},
url = {https://europepmc.org/article/MED/42928831},
note = {CC BY},
}
RIS
TY - JOUR
TI - High-Dose Tigecycline for Multidrug-Resistant Serratia Infections in Critically Ill Adults: A Systematic Review of Direct and Indirect Clinical Evidence.
AU - Arnab Choudhury
AU - Ashutosh Chaturvedi
AU - Adil Ashraf
AU - K V Padmaprakash
PY - 2026
DA - 2026/09/25
JO - Cureus
DO - 10.7759/cureus.116890
UR - https://europepmc.org/article/MED/42928831
AB - Evidence for high-dose tigecycline in severe multidrug-resistant Gram-negative infections comes mainly from non-Serratia cohorts. Its value in critically ill adults with resistant Serratia infection is uncertain. PubMed/MEDLINE, CENTRAL, and Consensus were searched up to July 17, 2026. Two evidence sets addressed high-dose tigecycline effectiveness, pharmacokinetics, and safety, and clinical and microbiological evidence for resistant Serratia. Study-level risk ratios were presented without pooling. Searches identified 2,294 records, and 36 studies reported in 37 publications were included. No study reported a verified high-dose regimen in confirmed resistant Serratia infection with a separately extractable organism-specific outcome. Six observational studies used the same high-dose and standard-dose definitions. Fixed 28-day or 30-day mortality risk ratios ranged from 0.34 to 1.30, and all 95% confidence intervals crossed 1.0. Clinical response favored high dose in two studies, with risk ratios of 1.73 (95% confidence interval: 1.22-2.46) and 1.48 (95% confidence interval: 1.08-2.02). Microbiological response favored high dose in two studies, with risk ratios of 1.75 (95% confidence interval: 1.09-2.81) and 1.92 (95% confidence interval: 1.12-3.28). No pooled estimate was calculated. High dose produced a greater fibrinogen decline in one cohort (-3.05 ± 1.67 versus -1.75 ± 1.90 g/L; p=0.038) and more hepatic or platelet abnormalities in another. Direct evidence for high-dose tigecycline in resistant Serratia infection is absent. Indirect studies show possible response benefits without a consistent survival advantage. Treatment decisions should consider infection site, susceptibility, active alternatives, and coagulation risk. By synthesizing both pathogen-specific studies and relevant indirect clinical evidence, this review aimed to provide a more comprehensive assessment of the potential role of high-dose tigecycline in critically ill adults with resistant S. marcescens infections.
SN - 2168-8184
ER -