title: Tigecycline Therapy in an Infant for Ventriculoperitoneal Shunt Meningitis.
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.
authors.affiliation: Departments of Pediatric Infectious Diseases and mkeser17@gmail.com.
authors.forename: Melike
authors.initials: M
authors.lastname: Emiroglu
authors.affiliation: Departments of Pediatric Infectious Diseases and.
authors.forename: Gulsum
authors.initials: G
authors.lastname: Alkan
authors.affiliation: Microbiology, Selcuk University Faculty of Medicine, Konya, Turkey.
authors.forename: Hatice
authors.initials: H
authors.lastname: Turk Dagi
mesh_terms: D000583:Amikacin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007278:Injections, Spinal; D007710:Klebsiella Infections / Q000188:drug therapy*; D007711:Klebsiella pneumoniae; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy*; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D056687:Off-Label Use; D016879:Salvage Therapy; D013845:Thienamycins / Q000627:therapeutic use; D000078304:Tigecycline; D017287:Ventriculoperitoneal Shunt
chemical_list: D013845:Thienamycins; D000078304:Tigecycline; D000583:Amikacin; D000077731:Meropenem; D008911:Minocycline