Clinical experience of Tigecycline in pediatric and neonatal patients in a tertiary care hospital in Pakistan”.
DOI:
https://doi.org/10.17720/d6q6m940Abstract
Background:
The rise of Multi-Drug Resistant (MDR) and Extensively Drug Resistant (XDR) infections has led to fewer choices of antimicrobials in the pediatric population. Since tigecycline has in vitro activity against gram-positive and gram-negative infections, it can be used as a combination therapy in pediatric and neonatal populations.
Objective:
To study tigecycline use for MDR and XDR infections, and microbiological and clinical outcomes in pediatrics and neonates.
Methods:
Retrospective chart review was performed for twenty-eight pediatric and neonatal patients who received tigecycline at least 48 hours after a report of antimicrobial susceptibility at different culture sites. The outcomes observed were microbial eradication, clinical improvement, mortality, and adverse effects in the described patients.
Results:
The median duration of therapy was 11 days, and median length of stay in the hospital was 30 days. Twenty-two (78.6%) children were in the intensive care unit with median length of stay of 13 days. Microbiological eradication was checked in only twenty patients, achieved in 15 (75%) children with a median duration of 2.5 (2-3) days. The mortality rate of patients was 11 (39.3%), among which three (11%) had multidrug-resistant, seven (25%) had extensive drug-resistant, and one patient had a pan-sensitive pathogen. The highest rate of mortality was associated with bloodstream infections, although there was no statistical significance associated.
Conclusion:
Tigecycline is an option for children mainly due to infections caused by MDR and XDR pathogens. More prospective and controlled trials are needed to determine the relationship between dosing and pharmacokinetic parameters for this population set.
Downloads
References
Elshamy AA, Aboshanab KM. A review on bacterial resistance to carbapenems: epidemiology, detection and treatment options. Future science OA. 2020;6(3):FSO438.
Livermore DM, Woodford N. The β-lactamase threat in Enterobacteriaceae, Pseudomonas and Acinetobacter. Trends in microbiology. 2006;14(9):413-20.
Morrill HJ, Pogue JM, Kaye KS, LaPlante KL, editors. Treatment options for carbapenem-resistant Enterobacteriaceae infections. Open forum infectious diseases; 2015: Oxford University Press.
Yaghoubi S, Zekiy AO, Krutova M, Gholami M, Kouhsari E, Sholeh M, et al. Tigecycline antibacterial activity, clinical effectiveness, and mechanisms and epidemiology of resistance: narrative review. European Journal of Clinical Microbiology & Infectious Diseases. 2021:1-20.
Zha L, Pan L, Guo J, French N, Villanueva EV, Tefsen B. Effectiveness and safety of high dose tigecycline for the treatment of severe infections: a systematic review and meta-analysis. Advances in therapy. 2020;37(3):1049-64.
Kuo S-C, Wang F-D, Fung C-P, Chen L-Y, Chen S-J, Chiang M-C, et al. Clinical experience with tigecycline as treatment for serious infections in elderly and critically ill patients. Journal of Microbiology, Immunology and Infection. 2011;44(1):45-51.
Sharland M, Rodvold KA, Tucker HR, Baillon-Plot N, Tawadrous M, Hickman MA, et al. Safety and efficacy of tigecycline to treat multidrug-resistant infections in pediatrics: an evidence synthesis. The Pediatric infectious disease journal. 2019;38(7):710-5.
Mastrolia MV, Galli L, De Martino M, Chiappini E. Use of tigecycline in pediatric clinical practice. Expert review of anti-infective therapy. 2017;15(6):605-12.
İpek MS, Gunel ME, Ozbek E. Tigecycline Use in Neonates: 5-Year Experience of a Tertiary Center. Journal of Pediatric Infectious Diseases. 2019;14(03):103-7.
Zhu ZY, Yang JF, Ni YH, Ye WF, Wang J, Wu ML. Retrospective analysis of tigecycline shows that it may be an option for children with severe infections. Acta Paediatrica. 2016;105(10):e480-e4.
Purdy J, Jouve S, Yan JL, Balter I, Dartois N, Cooper CA, et al. Pharmacokinetics and safety profile of tigecycline in children aged 8 to 11 years with selected serious infections: a multicenter, open-label, ascending-dose study. Clinical therapeutics. 2012;34(2):496-507. e1.
Slover CM, Rodvold KA, Danziger LH. Tigecycline: a novel broad-spectrum antimicrobial. Annals of Pharmacotherapy. 2007;41(6):965-72.
Iosifidis E, Violaki A, Michalopoulou E, Volakli E, Diamanti E, Koliouskas D, et al. Use of tigecycline in pediatric patients with infections predominantly due to extensively drug-resistant gram-negative bacteria. Journal of the Pediatric Infectious Diseases Society. 2017;6(2):123-8.
Ozkaya-Parlakay A, Gulhan B, Kanik-Yuksek S, Guney D, Gonulal D, Demirtas G, et al. Tigecycline therapy in pediatric patients with multidrug resistant bacteremia. Enfermedades infecciosas y microbiologia clinica (English ed). 2020;38(10):471-3.
Chen F, Shen C, Pang X, Zhang Z, Deng Y, Han L, et al. Effectiveness of tigecycline in the treatment of infections caused by carbapenem‐resistant gram‐negative bacteria in pediatric liver transplant recipients: A retrospective study. Transplant Infectious Disease. 2020;22(1):e13199.
Chopra I, Roberts M. Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance. Microbiology and molecular biology reviews. 2001;65(2):232-60.
Peterson LR. A review of tigecycline—the first glycylcycline. International journal of antimicrobial agents. 2008;32:S215-S22.
Eckmann C, Heizmann W, Bodmann K-F, von Eiff C, Petrik C, Loeschmann P-A. Tigecycline in the treatment of patients with necrotizing skin and soft tissue infections due to multiresistant bacteria. Surgical infections. 2015;16(5):618-25.
Kenney B, Stack G. Drug-induced thrombocytopenia. Archives of pathology & laboratory medicine. 2009;133(2):309-14.
Hurtado IC, Trujillo M, Restrepo A, Garcés C, Tamayo C, Mesa JG. Experience with tigecycline compassionate use in pediatric patients infected with carbapenem resistant Klebsiella pneumoniae. Revista chilena de infectologia: organo oficial de la Sociedad Chilena de Infectologia. 2012;29(3):317-21.
Akdağ D, Işıkgöz-Taşbakan M, Pullukcu H, Sipahi H, Sipahi OuRa. Tigecycline versus INR increase; more than expected? Expert opinion on drug safety. 2020;19(3):335-7.
Maximova N, Zanon D, Verzegnassi F, Granzotto M. Neutrophils Engraftment Delay During Tigecycline Treatment in 2 Bone Marrow–transplanted Patients. Journal of pediatric hematology/oncology. 2013;35(1):e33-e7.
Prot-Labarthe S, Youdaren R, Benkerrou M, Basmaci R, Lorrot M. Pediatric acute pancreatitis related to tigecycline. The pediatric infectious disease Journal. 2010;29(9):890-1.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Author
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
