Top

Published in:

01-10-2018 | Original Article

Preliminary experience with tigecycline treatment for severe infection in children

Authors: Sheng Ye, Chenmei Zhang, Shupeng Lin

Published in: European Journal of Pediatrics | Issue 10/2018

Abstract

Severe infection is a primary cause of mortality in children facing challenges from multidrug-resistant (MDR) pathogens, particularly MDR Acinetobacter baumannii. Tigecycline has an expanded spectrum of antibacterial activity, and some successful instances of its use in children have been reported. We conducted a retrospective chart review of children treated at a tertiary hospital between May 1, 2012 and May 1, 2017 to examine the efficacy and safety of tigecycline in children with severe infection. A total of 110 patients (69 males) were enrolled in this study, including 46 MDR A. baumannii infection patients, encompassing 51 A. baumannii strains. Totally, the median duration of tigecycline therapy was 10 days (range, 2–47 days), with a clinical improvement rate of 47.27% (52/110). In A. baumannii infection group, the clinical improvement rate was 50% (23/46) and the microbiology eradication rate was 50.98% (26/51). No adverse events were reported during therapy; however, in one case, a 9-year-old boy with hematologic disease developed tooth discoloration.

Conclusion: Although some patients benefited from tigecycline, the efficacy and safety of tigecycline should not be overvalued. Additional data from randomized controlled trials are required to assess the administration of tigecycline.

What is Known:

• Severe infection is a primary cause of mortality in pediatric patients and its treatment is facing challenges from an increasing number of multidrug-resistant (MDR) pathogens.

• Tigecycline has an expanded spectrum of antibacterial activity.

• Several case reports have indicated that tigecycline could be used as a salvage therapy in children when options are limited or non-existent.

What is New:

• We found that rate of clinical improvement was different in various groups of different infection. The efficacy of tigecycline should not be overvalued.

• Six dosage models and different infection types were observed in our series, with different improvement and eradication rate, indicating that more data are required to identify a proper tigecycline dosage.

Breuling T, Tschiedel E, Grosse-Lordemann A, Hunseler C, Schmidt C, Niemann F, Dettmer P, Freymann H, von Noorden C, Wallot M, Heister P, Heitmann F, Rothoeft T, Schurmann U, Backendorf A, Heldmann M, Schubert E, Nunez FB, Seiffert P, Felderhoff-Muser U, Dohna-Schwake C (2015) Septic shock in children in an urban area in Western Germany—outcome, risk factors for mortality and infection epidemiology. Klin Padiatr 227(2):61–65. https://doi.org/10.1055/s-0034-1398690 CrossRefPubMed

Costa Pde O, Atta EH, Silva AR (2015) Infection with multidrug-resistant gram-negative bacteria in a pediatric oncology intensive care unit: risk factors and outcomes. J Pediatr 91(5):435–441. https://doi.org/10.1016/j.jped.2014.11.009 CrossRef

Dinleyici EC, Yargic ZA, Bor O, Kiremitci A, Durmaz G (2010) Tigecycline treatment of multi-drug-resistant Corynebacterium jeikeium infection in a child with relapsing and refractory acute lymphoblastic leukemia. Pediatr Blood Cancer 55(2):349–351. https://doi.org/10.1002/pbc.22527 CrossRefPubMed

Dizbay M, Altuncekic A, Sezer BE, Ozdemir K, Arman D (2008) Colistin and tigecycline susceptibility among multidrug-resistant Acinetobacter baumannii isolated from ventilator-associated pneumonia. Int J Antimicrob Agents 32(1):29–32. https://doi.org/10.1016/j.ijantimicag.2008.02.016 CrossRefPubMed

Du X, Fu Y, Yu Y (2013) Tigecycline treatment of infection caused by KPC-producing Escherichia coli in a pediatric patient. Ann Clin Microbiol Antimicrob 12:19. https://doi.org/10.1186/1476-0711-12-19 CrossRefPubMedPubMedCentral

Emiroglu M, Alkan G, Turk Dagi H (2017) Tigecycline therapy in an infant for ventriculoperitoneal shunt meningitis. Pediatrics 139(1):e20160963. https://doi.org/10.1542/peds.2016-0963 CrossRefPubMed

Fang C, Chen X, Zhou M (2016) Epidemiology and cytokine levels among children with nosocomial multidrug-resistant Acinetobacter baumannii complex in a tertiary hospital of Eastern China. PLoS One 11(8):e0161690. https://doi.org/10.1371/journal.pone.0161690 CrossRefPubMedPubMedCentral

Foresti S, Di Bella S, Rovelli A, Sala A, Verna M, Bisi L, Nisii C, Gori A (2015) Tigecycline lock therapy for catheter-related bloodstream infection caused by KPC-producing Klebsiella pneumoniae in two pediatric hematological patients. Antimicrob Agents Chemother 59(12):7919–7920. https://doi.org/10.1128/AAC.01855-15 CrossRefPubMedPubMedCentral

Fournier PE, Richet H (2006) The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 42(5):692–699. https://doi.org/10.1086/500202 CrossRefPubMed

10.

Freire AT, Melnyk V, Kim MJ, Datsenko O, Dzyublik O, Glumcher F, Chuang YC, Maroko RT, Dukart G, Cooper CA, Korth-Bradley JM, Dartois N, Gandjini H, Study G (2010) Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagn Microbiol Infect Dis 68(2):140–151. https://doi.org/10.1016/j.diagmicrobio.2010.05.012 CrossRefPubMed

11.

Iosifidis E, Violaki A, Michalopoulou E, Volakli E, Diamanti E, Koliouskas D, Antachopoulos C, Drossou-Agakidou V, Sdougka M, Roilides E (2017) Use of tigecycline in pediatric patients with infections predominantly due to extensively drug-resistant gram-negative bacteria. J Pediatr Infect Dis Soc 6(2):123–128. https://doi.org/10.1093/jpids/piw009 CrossRef

12.

Jaspan HB, Brothers AW, Campbell AJ, McGuire JK, Browd SR, Manley TJ, Pak D, Weissman SJ (2010) Multidrug-resistant Enterococcus faecium meningitis in a toddler: characterization of the organism and successful treatment with intraventricular daptomycin and intravenous tigecycline. Pediatr Infect Dis J 29(4):379–381. https://doi.org/10.1097/INF.0b013e3181c806d8 PubMedPubMedCentralCrossRef

13.

Kanik-Yuksek S, Tezer H, Ozkaya-Parlakay A, Gulhan B, Sayed-Oskovi H, Kara A, Senel E (2015) Multidrug-resistant Acinetobacter baumannii bacteremia treated with tigecycline in two pediatric burn patients. Pediatr Infect Dis J 34(6):677. https://doi.org/10.1097/INF.0000000000000699 CrossRefPubMed

14.

Li J, Yang X, Chen L, Duan X, Jiang Z (2017) In vitro activity of various antibiotics in combination with tigecycline against Acinetobacter baumannii: a systematic review and meta-analysis. Microbial drug resistance (Larchmont, NY) 23(8):982–993. https://doi.org/10.1089/mdr.2016.0279 CrossRef

15.

Lin YS, Hung MH, Chen CC, Huang KF, Ko WC, Tang HJ (2016) Tigecycline salvage therapy for necrotizing fasciitis caused by Vibrio vulnificus: case report in a child. J Microbiol Immunol Infect 49(1):138–141. https://doi.org/10.1016/j.jmii.2013.04.008 CrossRefPubMed

16.

Maximova N, Zanon D, Verzegnassi F, Granzotto M (2013) Neutrophils engraftment delay during tigecycline treatment in 2 bone marrow-transplanted patients. J Pediatr Hematol Oncol 35(1):e33–e37. https://doi.org/10.1097/MPH.0b013e318279eec2 CrossRefPubMed

17.

Prot-Labarthe S, Youdaren R, Benkerrou M, Basmaci R, Lorrot M (2010) Pediatric acute pancreatitis related to tigecycline. Pediatr Infect Dis J 29(9):890–891. https://doi.org/10.1097/INF.0b013e3181e83a85 CrossRefPubMed

18.

Purdy J, Jouve S, Yan JL, Balter I, Dartois N, Cooper CA, Korth-Bradley J (2012) Pharmacokinetics and safety profile of tigecycline in children aged 8 to 11 years with selected serious infections: a multicenter, open-label, ascending-dose study. Clin Ther 34(2):496–507 e491. https://doi.org/10.1016/j.clinthera.2011.12.010 CrossRefPubMed

19.

Ramirez J, Dartois N, Gandjini H, Yan JL, Korth-Bradley J, McGovern PC (2013) Randomized phase 2 trial to evaluate the clinical efficacy of two high-dosage tigecycline regimens versus imipenem-cilastatin for treatment of hospital-acquired pneumonia. Antimicrob Agents Chemother 57(4):1756–1762. https://doi.org/10.1128/AAC.01232-12 CrossRefPubMedPubMedCentral

20.

Schwab KS, Hahn-Ast C, Heinz WJ, Germing U, Egerer G, Glasmacher A, Leyendecker C, Marklein G, Nellessen CM, Brossart P, von Lilienfeld-Toal M (2014) Tigecycline in febrile neutropenic patients with haematological malignancies: a retrospective case documentation in four university hospitals. Infection 42(1):97–104. https://doi.org/10.1007/s15010-013-0524-x CrossRefPubMed

21.

Tucker H, Wible M, Gandhi A, Quintana A (2017) Efficacy of intravenous tigecycline in patients with Acinetobacter complex infections: results from 14 phase III and phase IV clinical trials. Infect Drug Resist 10:401–417. https://doi.org/10.2147/IDR.S143306 CrossRefPubMedPubMedCentral

22.

Tugcu D, Turel O, Aydogan G, Akcay A, Salcioglu Z, Akici F, Sen H, Demirkaya M, Taskin N, Gurler N (2015) Successful treatment of multiresistant Achromobacter xylosoxidans bacteremia in a child with acute myeloid leukemia. Ann Saudi Med 35(2):168–169. https://doi.org/10.5144/0256-4947.2015.168 CrossRefPubMedPubMedCentral

23.

Wyeth Pharmaceuticals Inc. asoPI (2005) TYGACIL—tigecycline injection, powder, lyophilized, for solution. http://labeling.pfizer.com/showlabeling.aspx?id=491

24.

Xu L, Wang YL, Du S, Chen L, Long LH, Wu Y (2016) Efficacy and safety of tigecycline for patients with hospital-acquired pneumonia. Chemotherapy 61(6):323–330. https://doi.org/10.1159/000445425 CrossRefPubMed

25.

Zhu ZY, Yang JF, Ni YH, Ye WF, Wang J, Wu ML (2016) Retrospective analysis of tigecycline shows that it may be an option for children with severe infections. Acta Paediatr 105(10):e480–e484. https://doi.org/10.1111/apa.13516 CrossRefPubMed

Title: Preliminary experience with tigecycline treatment for severe infection in children
Authors: Sheng Ye
Chenmei Zhang
Shupeng Lin
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 10/2018
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-018-3208-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Preliminary experience with tigecycline treatment for severe infection in children

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 10/2018

Fitness and academic performance in adolescents. The mediating role of leptin: DADOS study

Neutrophil gelatinase-associated lipocalin as predictor of acute kidney injury in neonates with perinatal asphyxia: a systematic review and meta-analysis

Cleaning the genitalia with plain water improves accuracy of urine dipstick in childhood

Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8–12 weeks of life

Managing cyclic vomiting syndrome in children: beyond the guidelines

Prevalence of vitamin D deficiency in cord blood of newborns and the association with maternal vitamin D status