title: Use of Tigecycline in Pediatric Patients With Infections Predominantly Due to Extensively Drug-Resistant Gram-Negative Bacteria.
abstract: Emergence of extensively drug-resistant (XDR) bacteria has forced clinicians to use off-label antimicrobial agents such as tigecycline. We present our experience on salvage use of tigecycline for the treatment of infections caused by XDR Gram-negative bacteria in critically ill children and review published cases.
  We conducted a retrospective chart review in pediatric departments of a tertiary level hospital from January 2009 to May 2014. Patients were identified using pharmacy database. For the literature review, relevant articles were identified from PubMed.
  In our case series, 13 children (7 males) with a median age of 8 years (range, 2.5 months-14 years) received tigecycline for ≥2 days as treatment for healthcare-associated infections including 5 bacteremias, 6 lower respiratory tract infections, and 3 other infections. Isolated pathogens were XDR Gram-negative bacteria except 1. A loading dose (range, 1.8-6.5 mg/kg) was given in all except 2 cases. Maintenance dose was given at 1-3.2 mg/kg q12 h. Other antimicrobials including colistin and aminoglycosides (85% and 62%, respectively) were coadministered to all patients. No serious adverse events were detected in these very ill children. Twenty cases of children treated with tigecycline were previously published, mostly for multidrug-resistant/XDR bacteria. An episode of acute pancreatitis and neutrophil engraftment delay in 2 cases were reported during tigecycline treatment. Analyzing reported and all our cases together, mortality in bloodstream infections was 86%, whereas in nonbacteremic cases it was 24% (P = .009).
  Tigecycline, given at the range of administered doses as salvage therapy and in combination with other antimicrobial agents, seemed to be well tolerated in a series of mainly critically ill pediatric patients and demonstrated relatively good clinical response in nonbacteremic patients.
authors.affiliation: Infectious Diseases Unit, 3rd Department of Pediatrics.
authors.forename: Elias
authors.initials: E
authors.lastname: Iosifidis
authors.affiliation: Pediatric Intensive Care Unit.
authors.forename: Asimenia
authors.initials: A
authors.lastname: Violaki
authors.affiliation: Pediatric Intensive Care Unit.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Michalopoulou
authors.affiliation: Pediatric Intensive Care Unit.
authors.forename: Elena
authors.initials: E
authors.lastname: Volakli
authors.affiliation: 1st Department of Neonatology and Neonatal Intensive Care Unit, Medical Faculty, Aristotle University School of Health Sciences, and.
authors.forename: Elisavet
authors.initials: E
authors.lastname: Diamanti
authors.affiliation: Pediatric Oncology Department, Hippokration Hospital, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Koliouskas
authors.affiliation: Infectious Diseases Unit, 3rd Department of Pediatrics.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Antachopoulos
authors.affiliation: 1st Department of Neonatology and Neonatal Intensive Care Unit, Medical Faculty, Aristotle University School of Health Sciences, and.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Drossou-Agakidou
authors.affiliation: Pediatric Intensive Care Unit.
authors.forename: Maria
authors.initials: M
authors.lastname: Sdougka
authors.affiliation: Infectious Diseases Unit, 3rd Department of Pediatrics.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D000078304:Tigecycline; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline
keywords: Gram-negative bacteria; critically ill children; extensive-drug resistance; healthcare-associated infections; tigecycline