Tigecycline Therapy For Multidrug-resistant Bacteria Infections In Children After Surgery

Objective:Emergence of multidrug-resistant(MDR)and extensive drug-resistant(XDR)bacteria has forced physicians to use off-label antimicrobial agents such as tigecycline.We present our experience on tigecycline for the treatment of infections caused by MDR/XDR bacteria in critically ill children after surgery.Methods:This retrospective study investigated the effects of tigecycline in critically ill children either as single agent or in combination with other antimicrobial agents in a surgical Intensive Care Unit of a tertiary hospital from June 2012 to May 2016.Results:(1)In our case series,22 children(13 males)with age from 45days to 11 years received tigecycline for>3 days as treatment for life-threatening infections after surgery.18 patients with congenital heart disease(CHD)received intracardiac procedures,2 patients with extensive deep burns,1 patients received Intestinal resection and anastomosis,1 patients received craniocerebral operations.They had SOFA scores and PRISM ? scores on initiation tigecycline of 5.7±3.8and10.6±6.3 respectively,indicating high overall disease severity.(2)Off-label use of tigecycline in all patients,the most common use in VAP(54.5%).(3)We found that tigecycline therapy of 20 children was prescribed as empirical treatment,others were culture-directed prescription.(4)We detected pathogens of positive cultures in 20 cases before starting tigecycline treatment.Acinetobacter baumannii was the most frequently isolates(37 of 48,77%).(5)A11 children received tigecycline(initial dose 1.5mg/kg and thenl-1.2/kg mg every 12 h)range from 4 days to 22days.(6)Overall,The clinical success rate was 86.4%.Four of the patients(18%)died during SICU stay,and only one of these deaths was considered to be infection related.No serious drug-related adverse events were detected in these very sick children.Conclusions:Tigecycline achieved favorable clinical success rates in pediatric patients after surgery with high severity of illness and a high prevalence of multidrug-resistant pathogens and showed a good safety and tolerability profile.