Tigecycline Use in Patient with Intra-Abdominal Abscess,Beta-Lactam Allergy,and Acute Kidney Injury

A 72-year-old man, allergic to beta-lactam antibiotics, underwent pelvic exenteration because of recurrence of a rectal neoplasm involving the bladder. Tobramycin 300 mg and metronidazole 500 mg intravenously (IV) were used preoperatively for prevention of surgical site infection.

The sixth day after surgery, he presented with a temperature of 39° C and abdominal pain located in the hypogastrium, without peritonitis. Laboratory data revealed a white blood cell count of 18,000/mm³ and a serum creatinine concentration of 2.5 mg/dL. An abdominal computed tomography (CT) scan showed a 15×6-cm abscess beginning at the inferior edge of the spleen and extending caudally through the left lateroconal fascia (Fig. 1A), and another abscess in the pelvis (Fig. 1B). Given the history of allergy to beta-lactam drugs and his acute kidney injury, empiric broad-spectrum treatment with tigecycline was started (100 mg loading dose, continuing with 50 mg/12 h IV) and maintained for 14 d [1–5]. Percutaneous drainage of the left-sided abscess and drainage through the rectal stump of the pelvic abscess was established. The cultures of the drained material grew Enterococcus faecalis and Escherichia coli sensitive to piperacillin-tazobactam, meropenem, gentamicin, and tigecycline. The patient recovered satisfactorily and was discharged 22 d after admission, with a follow-up CT scan showing complete resolution of both abscesses.

OPEN IN VIEWER

FIG. 1.

Computed tomography scans of lesions. (A) Abscess extending caudally through left lateroconal fascia. (B) Pelvic abscess.