Tigecycline Therapy in an Infant for Ventriculoperitoneal Shunt Meningitis.
Pediatrics
; 139(1)2017 01.
Article
in En
| MEDLINE
| ID: mdl-27974589
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 ß-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.
Full text:
1
Collection:
01-internacional
Health context:
2_ODS3
/
3_ND
/
4_TD
/
7_ODS3_muertes_prevenibles_nacidos_ninos
Database:
MEDLINE
Main subject:
Klebsiella Infections
/
Meningitis, Bacterial
/
Ventriculoperitoneal Shunt
/
Hydrocephalus
/
Infant, Premature, Diseases
/
Klebsiella pneumoniae
/
Minocycline
Type of study:
Clinical_trials
Limits:
Humans
/
Infant
/
Male
Language:
En
Journal:
Pediatrics
Year:
2017
Document type:
Article