Intraventricular tigecycline for the treatment of shunt infection: a case in pediatrics

Abstract

<jats:p>Ventriculoperitoneal (VP) shunt infections are seen in 3%–17% of patients with VP shunts. These infections may cause severe morbidity and mortality. Staphylococci are the most common cause of CSF shunt-associated infections, although gram-negative bacteria (especially multidrug-resistant [MDR] and extensive drug–resistant [XDR] bacteria) also play an important role. Due to increased antibiotic resistance, sometimes off-label usage of antibiotics is considered. Tigecycline is one of these antibiotics. It should not be used unless there are no other antibiotic treatment options available, especially in children. It belongs to the glycylcycline class of antibiotic agents and inhibits protein translation in bacteria by binding to the 30S ribosomal subunit. The authors describe the case of a patient who had an XDR <jats:italic>Klebsiella pneumoniae</jats:italic>–positive VP shunt infection. After removal of his VP shunt, an external ventricular drain was inserted, and the patient was treated with a combination of intravenous (1.2 mg/kg/day) and intraventricular (4 mg/day) tigecycline in addition to his meropenem (120 mg/kg/day) treatment. On the 7th day of the combined therapy, his CSF culture was sterile. Because tigecycline distribution into the tissues is not sufficient with intravenous administration, combining it with intraventricular infusion can provide new treatment methods. However, further studies are needed for its use as a treatment method in children.</jats:p>

The Investigation on Nosocomial Infection of Acinetobacter baumannii and the Clinical Analysis of Sequential Therapy of Cefoperazone/Sulbactam Sodium for Intracranial Infection

“…Tigecycline, the glycylcycline antibiotics, has bacteriostatic effect on multidrug-resistant bacteria such as carbapenem-resistant Acinetobacter and Klebsiella pneumoniae, and its binding ability to bacterial ribosomes is stronger than that of other tetracycline antibiotics, so it is often used clinically in the treatment of complex skin and soft tissue infections, intra-abdominal infections, acquired pneumonia, and other diseases in adults [ 10 ]. Many studies showed that tigecycline had positive in vitro antibacterial activity against resistant Acinetobacter baumannii, but sole use of it may lead to resistant bacteria [ 11 , 12 ]. Cefoperazone sulbactam sodium, the broad-spectrum antibiotic, has a certain therapeutic effect on respiratory tract infections, urogenital infections, intra-abdominal infections, bone and joint infections, intracranial infections, and skin and soft tissue infections caused by sensitive bacteria [ 13 , 14 ].…”

Dose optimisation of antibiotics used for meningitis

“…Three case reports in patients receiving tigecycline 50 mg intravenous twice-daily with CNS infections show a penetration ratio of between 0.07 and 0.85 based on point estimate comparisons with CSF concentrations ranging from 0.035 to 0.048 mg/L [74][75][76]. Intraventricular tigecycline administration has been used in small case series and case reports using doses up to 4 mg daily, which does not appear to be based on PK/PD targets [77][78][79][80]. One case report describes an approximate CSF AUC 0-24 of approximately 67 after a 1 mg twice-daily intraventricular dose and a CSF AUC 0-12 of approximately 670 with a 5 mg twice-daily intraventricular dose [81].…”

Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

“…Therefore, IVT administration is suggested in combination with IV carbapenems. 67 The guideline of the Infectious Diseases Society of America suggests that therapy should continue for 10 to 14 days after the last positive culture. 13 In 2018, the first pediatric IVT delivery of tigecycline was reported; the patient was an 8-month-old infant infected with XDR Klebsiella spp.…”