Effectiveness of tigecycline in the treatment of infections caused by carbapenem‐resistant gram‐negative bacteria in pediatric liver transplant recipients: A retrospective study

Abstract

Introduction Tigecycline (TGC) is effective for the infections caused by carbapenem‐resistant gram‐negative bacteria (CRGNB) in adults, but it is not investigated systematically in children because of concern about adverse effects. This study aimed to analyze the effectiveness of TGC in treating CRGNB infections in children after receiving liver transplant. Methods The subjects in this retrospective study were pediatric liver transplant recipients treated with TGC for at least 3 days to fight microbiologically verified CRGNB infection after initial antibiotic failure during the period from January 2014 to May 2018. Clinical and microbiological outcomes were reviewed to evaluate the efficacy and safety of TGC. Results Of the 1177 pediatric liver transplant recipients, 13 patients were eligible for inclusion in this analysis. All the patients received TGC at dose of 2 mg/kg every 12 hours for a duration of 10.1 ± 5.1 days on average to treat CRGNB infections, including complicated intra‐abdominal infection, ventilator‐associated pneumonia, and bloodstream infection. The isolates included Klebsiella pneumoniae (69.2%, 9/13) and Acinetobacter baumannii (30.8%, 4/13). Clinical efficacy was achieved in 84.6% (11/13) and pathogen eradicated in 69.2% (9/13) of the patients. The overall mortality rate was 15.4% (2/13). No TGC‐related serious adverse event was reported. Conclusion Tigecycline can be considered in combination antimicrobial regimen for treating CRGNB‐related infections in pediatric liver transplant recipients.

Bacterial Infections after Pediatric Liver Transplantation

“…Another concern for pathogens causing infection after transplantation is the emergence of resistant species such as MDR, XDR, and VRE. The results of our studies showed that about 25% of gram-negative species isolated from patients were XDR type; other studies in this eld also pointed to the high incidence of MDR and XDR pathogens after solid organ transplantation [29][30][31].The increase in rates of resistant pathogen species not only affects the e ciency of common antibiotic regimes, but also increases the mortality rate [32,33].Inappropriate administration of antibiotics in empirical conditions, longer hospital and ICU stays, frequent prescription of broad-spectrum antibiotics such as carbapenems and uoroquinolones in treatment of spontaneous bacterial peritonitis conditions before LT, as well as the need for hemodialysis or Continuous Renal Replacement Therapies (CRRT) after LT are among the risk factors for emerging resistant pathogens after LT [25,32].…”

Rising Klebsiella pneumoniae Infections and Its Expanding Drug Resistance in the Intensive Care Unit of a Tertiary Healthcare Hospital, Saudi Arabia

“…As practiced in many health care settings [ 24 ], tigecycline is used for the treatment of carbapenem-resistant Enterobacteriaceae infections, including K. pneumoniae . Tigecycline was found the best choice from the in vitro results reported in the present study as the susceptibility of K. pneumoniae was 81.9%.…”

Tigecycline for treatment of multidrug‐resistant gram‐negative bacteria in transplant recipient patients: Challenges of antimicrobial susceptibility testing

“…Chen et al recently described a case series of pediatric liver transplant recipients who received tigecycline for treatment of carbapenem-resistant Klebsiella pneumonia (in 9/13 cases, 69.2%) and Acinetobacter baumannii (4/13 cases, 30.8%). 2 Clinical efficacy, microbiological clearance, and overall mortality rate associated with tigecycline used in combination with other antibiotics were 84.6% (11/13), 69.2% (9/13), and 15.4% (2/13), respectively. 2 There was not serious adverse event related to tigecycline.…”

“…2 Clinical efficacy, microbiological clearance, and overall mortality rate associated with tigecycline used in combination with other antibiotics were 84.6% (11/13), 69.2% (9/13), and 15.4% (2/13), respectively. 2 There was not serious adverse event related to tigecycline. 2 [6][7][8] In conclusion, due to the alarming rise in antimicrobial resistance among gram-negative bacteria in general, and especially in transplant recipients, we urge stakeholders and thought-leaders to incentivize research required to establish antimicrobial clinical breakpoints that guide antimicrobial therapy and we strongly encourage the leading scientific committees to harmonize the clinical breakpoints for existing antimicrobial agents.…”

“…and Morganella morganii; and Providencia spp. and variable in other species.LETTER TO THE EDITOR criteria and zones of inhibition cutoffs used by Chen et al did not follow any of the established standards listed above [2][3][4][5]. To that end, there is an urgent need to develop diagnostic interpretive criteria for in vitro tigecycline susceptibility testing against gram-negative bacteria to guide appropriate and accurate antimicrobial therapy.…”