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Published on: October 14, 2022
Tigecycline Therapy in an Infant for Ventriculoperitoneal Shunt Meningitis
Melike Emiroglu1, Gulsum Alkan2, Hatice Turk Dagi3
1Departments of Pediatric Infectious Diseases and mkeser17@gmail.com.
Insights
Tigecycline, a last-resort antibiotic, successfully treated a multidrug-resistant bacterial meningitis in an infant with a cerebrospinal fluid shunt. This combination therapy offers a potential life-saving option for pediatric nosocomial infections when other treatments fail.
Area of Science:
- Pediatric Infectious Diseases
- Neurocritical Care
- Antimicrobial Stewardship
Background:
- Shunt infections complicate 3-20% of cerebrospinal fluid (CSF) shunt procedures.
- Gram-negative bacteria, particularly multidrug-resistant strains, are emerging as significant causes of shunt infections with high mortality.
- Tigecycline, a glycylcycline antibiotic, is not FDA-approved for pediatric use but shows potential in treating resistant infections.
Observation:
- A 5-month-old infant with a ventriculoperitoneal shunt developed meningitis caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae.
- Initial treatment with meropenem and gentamicin failed, leading to the emergence of carbapenem-resistant K. pneumoniae.
- The infected shunt was removed, and the infant received a combination regimen including intravenous tigecycline and intrathecal amikacin.
Findings:
- Cerebrospinal fluid sterilization was achieved within six days of initiating tigecycline treatment.
- The infant completed a 20-day course of tigecycline combined with meropenem.
- This case demonstrates the successful use of tigecycline as salvage therapy in a pediatric patient with refractory shunt-related meningitis.
Implications:
- Tigecycline, used cautiously as part of combination salvage therapy, can be a critical option for critically ill children with multidrug-resistant infections.
- Further research is warranted to establish efficacy and safety data for tigecycline in pediatric populations.
- This case highlights the growing challenge of nosocomial infections and the need for novel treatment strategies in pediatric neurosurgery.
Abstract:
Shunt infections are seen in 3% to 20% of patients who have cerebrospinal fluid (CSF) shunts. Although the staphylococcal species are the most common cause of shunt-related infections, Gram-negative bacteria are increasingly reported with higher mortality rates. Tigecycline, a glycylcycline, is not approved for children. But in the era of nosocomial infections due to multidrug-resistant pathogens, it can be the life-saving option. We report an infant with ventriculoperitoneal shunt-related meningitis treated with a tigecycline combination regimen. A 5-month-old boy who had a ventriculoperitoneal shunt was admitted with meningitis. Extended spectrum β-lactamase-producing Klebsiella pneumoniae grew in the CSF. At the end of the fourth week of intravenous meropenem plus gentamicin therapy, carbapenem-resistant K pneumoniae grew in the CSF (mean inhibitory concentration value for meropenem >4 μg/mL, by E-test). The infected shunt was removed, and an external ventricular drainage catheter was inserted. With permission, intravenous tigecycline (1.2 mg/kg per dose twice a day) and intrathecal amikacin were added to the meropenem. Intrathecal amikacin could be given for only 7 days. On the sixth day of tigecycline treatment, the CSF was sterilized. Antibiotic therapy was given and consisted of a total of 60 days of meropenem and 20 days of tigecycline therapy. Because no available efficacy and safety data from randomized-controlled studies exist, tigecycline must be used only as salvage therapy, in combination with other drugs, for critically ill children who have no alternative treatment options.
