Resistant bacterial infections have become more common in recent years, its treatment becomes a difficult problem. Tigecycline has a broad-spectrum antibacterial activity including resistant pathogens. Tigecycline may be a safe and important option in pediatric nosocomial infections due to resistant bacteria. Paediatric patients treated with tigecycline from 1 January 2010 to 31 October 2018 were analysed retrospectively to assess the efficacy and safety of tigecycline in children. Clinical response was considered cure in patients with all clinical signs of tigecycline-induced infection disappearing, a complete laboratory response, and improvement without further antibacterial therapy. The clinical response in patients who were not cured but recovered to the extent deemed appropriate by the researcher was evaluated as remission. Clinical response was considered failure in patients with no clinical improvement, culture positivity, acute-phase reactant elevation, and need for additi onal antibacterial therapy. There was a total of 25,251 patients, 1301 of whom were hospitalized in paediatric intensive care during the study. Paediatric patients who received tigecycline for at least 2 days (at least four doses) were analysed. This study included 91 children who received tigecycline treatment and met the inclusion criteria, aged 7 months to 17.5 years (median 8 years). The median length of hospital stay was 62 days (14–251 days). The median duration of antibiotic treatment before tigecycline treatment was 27 days (4–30 days). Among the most common were glycopeptides (95.6%) and carbapenems (89%). There were no significant differences in clinical response between tigecycline as monotherapy and as combined therapy (p = 0.742). Studies on the efficacy of tigecycline in children are not prospective due to safety concerns but contain data from limited cases in which it was used as salvage therapy. In our study, tigecycline was gi ven to 73.6% of patients as monotherapy, and this is the largest series involving monotherapy. The fact that the patients used long-term and multiple antimicrobial agents before tigecycline treatment (95.6% glycopeptides and 89% carbapenems) limited the options of antibiotics. Therefore, the rate of monotherapy was high, and clinical success did not differ significantly between patients who started tigecycline as monotherapy and combination therapy.
Abstract
What is known and objective
The frequency of multidrug-resistant bacterial infections is increasing worldwide. Tigecycline may be an important option for children with life-threatening nosocomial infections due to multidrug-resistant bacteria. However, there are few published data on the use of tigecycline in paediatric patients. By examining the results of tigecycline use in children, we aimed to draw attention to the fact that tigecycline may be an alternative in the treatment of resistant infections in children.
Methods
Paediatric patients treated with tigecycline from 1 January 2010 to 31 October 2018 at Eskişehir Osmangazi University Medical Faculty, which is a tertiary hospital, were analysed retrospectively to assess the efficacy and safety of tigecycline treatment in children. Patients using tigecycline were identified using the pharmacy database. Clinical and laboratory data were obtained from the files.
Results and discussion
This study included 91 children aged 7 months to 17.5 years; 52 were female (57.1%). At least one predisposing factor was present in 98.9% of the patients. Fifty-one bacteria were isolated from 44 patients. The tigecycline resistance rate was 3.9%. Only 2 of 91 patients experienced one or more side effects of tigecycline. Tigecycline can be used as salvage therapy in resistant infections where options are limited, although definitive conclusions about the efficacy and safety of tigecycline in children cannot be reached.
What is new and conclusion
Tigecycline may be a safe and important option in paediatric nosocomial infections due to resistant bacteria. Resistant bacterial infections have become more common in recent years, its treatment becomes a difficult problem. Tigecycline has a broad-spectrum antibacterial activity including resistant pathogens.
