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Preliminary experience with tigecycline treatment for severe infection in children
Sheng Ye1, Chenmei Zhang1, Shupeng Lin2
1Pediatric Intensive Care Unit, Children's Hospital Zhejiang University School of Medicine, No. 3333, Binsheng Road, Hangzhou, 310052, China.
Insights
Tigecycline shows moderate clinical improvement in children with severe infections, including multidrug-resistant Acinetobacter baumannii. Further randomized trials are needed to confirm its efficacy and safety in pediatric populations.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance
- Pharmacology
Background:
- Severe infections pose a significant mortality risk in children, exacerbated by multidrug-resistant (MDR) pathogens.
- Tigecycline, an antibiotic with a broad spectrum, has shown promise in limited pediatric cases.
- Existing data on tigecycline in children are primarily from case reports, highlighting the need for more extensive research.
Purpose of the Study:
- To evaluate the efficacy and safety of tigecycline in pediatric patients with severe infections.
- To assess clinical improvement and microbiological eradication rates associated with tigecycline therapy.
- To identify potential adverse events and factors influencing treatment outcomes in children.
Main Methods:
- Retrospective chart review of 110 pediatric patients treated with tigecycline between May 2012 and May 2017.
- Analysis of clinical improvement and microbiological eradication in patients with various severe infections, including MDR Acinetobacter baumannii.
- Documentation of adverse events and duration of tigecycline therapy.
Main Results:
- Overall clinical improvement rate was 47.27% (52/110) with a median tigecycline therapy duration of 10 days.
- In the multidrug-resistant Acinetobacter baumannii group, clinical improvement was 50% (23/46) and microbiological eradication was 50.98% (26/51).
- One case of tooth discoloration was reported in a child with hematologic disease; no other adverse events were noted.
Conclusions:
- Tigecycline demonstrated some benefit in treating severe pediatric infections, but its efficacy should be interpreted cautiously.
- Observed variations in improvement and eradication rates across different infection types and dosage regimens suggest the need for further investigation.
- Randomized controlled trials are essential to establish definitive efficacy, safety, and optimal dosing of tigecycline in pediatric patients.
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.
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