1
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Zhang X, Pan J, Zhang X, Yang Q, Li Z, Liu F. Safety profiles of tetracycline-class drugs: a pharmacovigilance analysis of the FAERS database. Expert Opin Drug Saf 2024:1-10. [PMID: 39158402 DOI: 10.1080/14740338.2024.2393276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/18/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND As synthesis technology advances, novel and efficient derivatives of tetracyclines are found. Three new antibiotics were approved within the past 18 years, and represent a new era in the use of tetracyclines. To gain further insight into adverse events linked to tetracyclines and better protect pediatric patients, ongoing monitoring of safety data is crucial. METHODS The FAERS data from the first quarter of 2004 to the third quarter of 2023 in the AERSMine were extracted to conduct disproportionality analysis. The association between five tetracyclines and adverse events was evaluated using reporting odds ratio, and their risk factors were explored by multivariate logistic regression analysis. RESULTS Our study showed that thyroid gland disorders had the strongest signal in children. Patients aged 12-18 and treatment with minocycline are risk factors for thyroid adverse events (12-18: OR = 10.727 [7.113-16.177], p < 0.0001; minocycline: OR = 17.025 [10.475-27.678], p < 0.0001). Second-generation tetracycline and third-generation tetracycline ADR patterns differed. Blood fibrinogen decreased and hypofibrinogenaemia was primarily reported with tigecycline and eravacycline. CONCLUSION This study provided basic evidence for further research on tetracyclines-related adverse events. However, the safety of third-generation tetracycline in children requires additional validation through a large-scale prospective study.
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Affiliation(s)
- Xu Zhang
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Juan Pan
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Xiaojuan Zhang
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Qiongliang Yang
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Zuyi Li
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Furong Liu
- Institute of Clinical Pharmacy, Department of Pharmacy, The Affiliated Nanhua Hospital, Hengyang Medical School, Hengyang, China
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2
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Kontou A, Kourti M, Iosifidis E, Sarafidis K, Roilides E. Use of Newer and Repurposed Antibiotics against Gram-Negative Bacteria in Neonates. Antibiotics (Basel) 2023; 12:1072. [PMID: 37370391 DOI: 10.3390/antibiotics12061072] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Antimicrobial resistance has become a significant public health problem globally with multidrug resistant Gram negative (MDR-GN) bacteria being the main representatives. The emergence of these pathogens in neonatal settings threatens the well-being of the vulnerable neonatal population given the dearth of safe and effective therapeutic options. Evidence from studies mainly in adults is now available for several novel antimicrobial compounds, such as new β-lactam/β-lactamase inhibitors (e.g., ceftazidime-avibactam, meropenem-vaborbactam, imipenem/cilastatin-relebactam), although old antibiotics such as colistin, tigecycline, and fosfomycin are also encompassed in the fight against MDR-GN infections that remain challenging. Data in the neonatal population are scarce, with few clinical trials enrolling neonates for the evaluation of the efficacy, safety, and dosing of new antibiotics, while the majority of old antibiotics are used off-label. In this article we review data about some novel and old antibiotics that are active against MDR-GN bacteria causing sepsis and are of interest to be used in the neonatal population.
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Affiliation(s)
- Angeliki Kontou
- 1st Department of Neonatology and Neonatal Intensive Care Unit, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Maria Kourti
- Infectious Diseases Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Elias Iosifidis
- Infectious Diseases Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Kosmas Sarafidis
- 1st Department of Neonatology and Neonatal Intensive Care Unit, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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3
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Aslan K, Kiliç Ö, Kiral E, Bozan G, Bör Ö, Dinleyici EÇ. Clinical and laboratory responses to tigecycline in children. J Clin Pharm Ther 2022; 47:1585-1590. [DOI: 10.1111/jcpt.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Kaan Aslan
- Department of Pediatrics Eskişehir Osmangazi University Medical Faculty Eskişehir Turkey
| | - Ömer Kiliç
- Division of Pediatric Infectious Diseases Eskişehir Osmangazi University Medical Faculty Eskişehir Turkey
| | - Eylem Kiral
- Division of Pediatric Intensive Care Unit Eskişehir Osmangazi University Medical Faculty Eskişehir Turkey
| | - Gürkan Bozan
- Division of Pediatric Intensive Care Unit Eskişehir Osmangazi University Medical Faculty Eskişehir Turkey
| | - Özcan Bör
- Division of Pediatric Hematology‐Oncology Eskişehir Osmangazi University Medical Faculty Eskişehir Turkey
| | - Ener Çağrı Dinleyici
- Division of Pediatric Intensive Care Unit Eskişehir Osmangazi University Medical Faculty Eskişehir Turkey
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4
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Nascimento ADS, Passaro MF, Silva PSDS, Rodriguez SF, Martins MK, Oliveira SCP, Moriel P, Visacri MB. Off-Label Use of Ceftazidime-Avibactam in a Premature Infant With Multidrug-Resistant Klebsiella pneumoniae Infection: A Case Report. J Pharm Pract 2022:8971900221087131. [PMID: 35414301 DOI: 10.1177/08971900221087131] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The emergence of multidrug-resistant (MDR) Gram-negative bacterial infections in the neonatal intensive care unit (NICU) is a major public health threat. Ceftazidime-avibactam (CAZ-AVI) provides a new option for treating infections caused by most beta-lactamase- and carbapenemase-producing Gram-negative bacteria in infants older than three months. However, treatment options are extremely limited, with no safety data available for preterm neonates. Here, we describe our experience regarding the safety and efficacy of off-label use of CAZ-AVI in a NICU in Brazil. SUMMARY We report a case of a premature infant (born at 29 weeks gestational age) treated with CAZ-AVI due to a bloodstream infection caused by MDR Klebsiella pneumoniae. CONCLUSION Treatment with CAZ-AVI was safe and effective in our patient.
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Affiliation(s)
| | - Marcos F Passaro
- 592445Irmandade da Santa Casa de Misericórdia de Santos, Santos, Brazil
| | | | | | | | | | - Patricia Moriel
- Faculty of Pharmaceutical Sciences, 28132University of Campinas, Campinas, Brazil
| | - Marília B Visacri
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, 28132University of São Paulo, São Paulo, Brazil
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5
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Leng B, Yan G, Wang C, Shen C, Zhang W, Wang W. Dose optimisation based on pharmacokinetic/pharmacodynamic target of tigecycline. J Glob Antimicrob Resist 2021; 25:315-322. [PMID: 33957288 DOI: 10.1016/j.jgar.2021.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Tigecycline, a new first-in-class glycylcycline antibiotic, has shown promising efficacy against a broad range of micro-organisms. It is widely prescribed for various infections, with most prescriptions being considered for off-label use. However, only a few years after its approval by the US Food and Drug Administration (FDA), tigecycline is suspected of increasing all-cause mortality. Some clinicians have suggested such unfavourable outcomes correlate with inadequate drug exposure at the infection site. The pharmacokinetic/pharmacodynamic (PK/PD) profile of a drug plays an important role in predicting its antibiotic effect, which for tigecycline is determined as the ratio of area under the concentration-time curve (AUC) to minimum inhibitory concentration (MIC). In this study, PK/PD targets based on infection sites, bacterial isolates and patient populations are discussed. Generally, a higher dosage of tigecycline for the treatment of serious infections has been recommended in previous reports. However, the latest finding of tigecycline's atypical protein binding property requires consideration when recommending further use. In addition, combination therapy with other antibiotics provides another option by potentially lowering the MICs of multidrug-resistant bacteria.
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Affiliation(s)
- Bing Leng
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Huaiyin District, Jinan 250021, China
| | - Genquan Yan
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Huaiyin District, Jinan 250021, China
| | - Cuicui Wang
- Medical Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Huaiyin District, Jinan 250021, China
| | - Chengwu Shen
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Huaiyin District, Jinan 250021, China
| | - Wen Zhang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Huaiyin District, Jinan 250021, China
| | - Wei Wang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Huaiyin District, Jinan 250021, China; Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
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6
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Potential Effectiveness of Piperacillin/Tazobactam in Treating Pediatric Patients Infected with IMP-Type Carbapenemase-Producing Enterobacteriaceae. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.103118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: The resistance rate of carbapenem-resistant Enterobacteriaceae (CRE) is increasing yearly but rarely reported in children. Objectives: This retrospective study analyzed the characteristics of isolated CRE strains in pediatric patients, intending to explore reasonable antimicrobial treatment options. Methods: Some CRE isolates were collected from infected pediatric patients in Liaocheng People’s Hospital from January 2014 to December 2019. The strain identification and antimicrobial susceptibility testing were conducted using Vitek mass spectrometry and the Vitek 2 system, respectively. The carbapenemase genotypes of blaKPC, blaIMP, blaVIM, blaNDM-1, and blaOXA-48 were each detected by polymerase chain reaction and sequencing. The molecular homology analysis of strains was conducted via Pulse-field Gel Electrophoresis (PFGE). The clinical data of CRE-infected pediatric patients were collected from the hospital’s medical data information system. Results: Twenty CRE strains were isolated from 1945 infected pediatric patients with Enterobacteriaceae. All CRE strains showed multiple resistance to commonly used antimicrobials. Twelve strains of imipenemase (IMP)-4 and seven strains of IMP-8 carbapenemase were confirmed. Besides, PFGE revealed that two strains of Escherichia coli and three of Klebsiella pneumoniae had indistinguishable patterns. Sixteen patients were cured, including 10 patients using piperacillin/tazobactam. Conclusions: This study found the major sources of resistance were IMP carbapenemases. Piperacillin/tazobactam is potentially effective for the treatment of CRE infection, despite insensitivity in vitro.
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7
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Avedissian SN, Rhodes NJ, Shaffer CL, Tran L, Bradley JS, Le J. Antimicrobial prescribing for treatment of serious infections caused by Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in pediatrics: an expert review. Expert Rev Anti Infect Ther 2021; 19:1107-1116. [PMID: 33554692 DOI: 10.1080/14787210.2021.1886923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), remains a significant pathogen in children. Despite evidence of decreasing prevalence, MRSA bacteremia has been closely associated with complications, including certain infections (i.e. musculoskeletal and endovascular) linked to increased treatment failures.Areas covered: This expert review summarized recent published literature on the role of treatment, dosing and administration of antibiotics used to combat serious S. aureus infections in children. The pertinent antibiotics presented were vancomycin, oxazolidinones, semi-synthetic glycopeptides, daptomycin, tigecycline, novel cephalosporins, fosfomycin and lefamulin. Vancomycin has been the most commonly used antibiotic in empiric therapy for serious MRSA infection, with new key recommendations emphasizing a different approach to dosing and therapeutic monitoring. For other antibiotics, data remain limited or clinical trials are underway.Expert opinion: MRSA remains a significant pathogen in the pediatric population. As numerous therapeutic agents are available, many agents have limited data on usage in pediatric patients. Future studies require pharmacokinetic, safety and efficacy studies in pediatric patients to ensure appropriate therapeutic treatment and outcomes. Phage therapy has been used to treat deep-seated MRSA infections and is an emerging investigational treatment option.
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Affiliation(s)
- Sean N Avedissian
- Antiviral Pharmacology Laboratory, University of Nebraska Medical Center (UNMC) Center for Drug Discovery, UNMC, Omaha, NE, USA.,University of Nebraska Medical Center, College of Pharmacy, Omaha, NE, USA
| | - Nathanial J Rhodes
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA.,Midwestern University College of Pharmacy, Downers Grove Campus, Pharmacometrics Center of Excellence, Downers Grove, IL USA
| | | | - Lan Tran
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - John S Bradley
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego School of Medicine and Rady Children's Hospital San Diego
| | - Jennifer Le
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
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8
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Xing H, Cheng C, Zhang Y, Cai Y, Wang X, Deng D, Xu L, Xu M, Chen J. Successful Treatment With Intrathecal and Intravenous Polymyxin B-Based Combination Against MDR Acinetobacter baumannii Meningitis in Pediatric Patient: A Case Report. Front Pediatr 2021; 9:564991. [PMID: 34386463 PMCID: PMC8353103 DOI: 10.3389/fped.2021.564991] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nosocomial meningitis with multidrug-resistant (MDR) or extensively drug-resistant (XDR) Acinetobacter baumannii is a life-threatening complication in neurosurgery. Treatment of these infections is challenging because of poor penetration of the available antibiotics into the cerebrospinal fluid (CSF). Intrathecal (ITH) or intraventricular (IVT) administration of antibiotics is increasingly used as the last treatment option against MDR/XDR Gram-negative bacteria meningitis not responding to intravenous (IV) regimens. However, pertinent data in pediatric patients is scarce. Case Presentation: A 14-year-old male patient developed meningitis from an MDR strain of A. baumannii following endoscopic endonasal resection of craniopharyngioma. Despite a combination therapy involving IV tigecycline, we observed clinical and bacteriologic failure. The patient was then successfully treated with an ITH and IV polymyxin B-based combination. Quantification of tigecycline and polymyxin B in CSF was performed with two-dimensional high-performance liquid chromatography (2D-HPLC) and HDLC coupled with tandem mass spectrometry (HPLC-MS/MS), respectively. Adverse drug reactions (neurotoxicity and skin hyperpigmentation), probably induced by polymyxin B, were acceptable and reversible. Conclusions: The case illustrates ITH and IV Polymyxin B-based combination is an optimal therapeutic option against MDR A. baumannii meningitis in this pediatric patient. In the future, real-time PK/PD data obtained from patients during ITH/IVT polymyxin B therapy should be required to optimize polymyxin use with maximal efficacy and minimal adverse effects.
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Affiliation(s)
- Haiyan Xing
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Caiyi Cheng
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yihua Zhang
- Department of Neurosurgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yongqing Cai
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Xianfeng Wang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Dongmei Deng
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Lunshan Xu
- Department of Neurosurgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Minhui Xu
- Department of Neurosurgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Jianhong Chen
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
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9
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Shi J, Sun T, Cui Y, Wang C, Wang F, Zhou Y, Miao H, Shan Y, Zhang Y. Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: a retrospective study in the pediatric intensive care unit. BMC Infect Dis 2020; 20:597. [PMID: 32787942 PMCID: PMC7422664 DOI: 10.1186/s12879-020-05321-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
Background Multidrug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors and overall mortality for MDR/XDR Acinetobacter baumannii infected pediatric patients. Methods This retrospective study included 102 pediatric patients who developed MDR/XDR Acinetobacter baumannii infection in the pediatric intensive care unit (PICU) of Shanghai Children’s Hospital in China from December 2014 to May 2018. Acinetobacter baumannii clinical isolates were recovered from different specimens including blood, sputum, bronchoalveolar lavage fluid, cerebrospinal fluid, ascites, hydrothorax, and urine. Antibiotic susceptibility test was determined according to the Clinical and Laboratory Standards Institute interpretive criteria. Clinical and biological data were obtained from the patients’ medical records. Results 102 patients with Acinetobacter baumannii infection were enrolled. The median age was 36 (9.6, 98.8) months, and there were 63 male in the case group. The overall mortality rate was 29.4%, while the Acinetobacter baumannii-associated mortality rate was 16.7% (17/102, 12 bloodstream infections, 4 meningitis and 1 intra-abdominal infection). Bloodstream infections occurred in 28 patients (27.5%), and 10 patients (9.8%) among them had central line-associated bloodstream infections (6 central venous catheters, 2 PICCs, 1 venous infusion port and 1 arterial catheter). Cerebrospinal fluid (CSF) cultures were positive in 4(3.9%) patients. 14(13.7%) patients got positive cultures in ascites and hydrothorax. Lower respiratory isolates (56/102) accounted for 54.9% of all patients. Non-survival patients appeared to have a lower NK cell activity (6.2% ± 3.61% vs. 9.15% ± 6.21%, P = 0.029), higher CD4+ T cell ratio (39.67% ± 12.18% vs. 32.66% ± 11.44%, P = 0.039),and a higher serum level of interlukin-8 (IL-8, 15.25 (1.62, 47.22)pg/mL vs. 0.1 (0.1, 22.99)pg/mL, P = 0.01) when Acinetobacter baumannii infection developed. Multivariate logistic analysis indicated that high serum level of Cr (RR, 0.934, 95%CI, 0.890–0.981; P = 0.007) and high BUN/ALB level (RR, 107.893, 95%CI, 1.425–870.574; p = 0.005) were associated with high risk of mortality in MDR/XDR Acinetobacter baumannii infected patients. Conclusion MDR/XDR Acinetobacter baumannii infection is a serious concern in pediatric patients with high mortality. Bloodstream and central nervous system infection accounted for high risk of death. Acute kidney injury is associated with high risk of mortality.
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Affiliation(s)
- Jingyi Shi
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Ting Sun
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Yun Cui
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Fei Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Yiping Zhou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Huijie Miao
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Yijun Shan
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China. .,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, 20062, China. .,Department of Critical Care Medicine, Shanghai, Children's Hospital, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China.
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10
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Bassetti M, Peghin M, Mesini A, Castagnola E. Optimal Management of Complicated Infections in the Pediatric Patient: The Role and Utility of Ceftazidime/Avibactam. Infect Drug Resist 2020; 13:1763-1773. [PMID: 32606826 PMCID: PMC7305847 DOI: 10.2147/idr.s209264] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/11/2020] [Indexed: 12/19/2022] Open
Abstract
Antimicrobial resistance poses a substantial threat to global public health. The pursuit of new antibiotics has decreased and very few options have been investigated for the treatment of complicated multidrug-resistant Gram-negative (MDR-GN) infections in adult population and even less in pediatric patients. Ceftazidime-avibactam (CAZ-AVI) is novel cephalosporin/β-lactamase inhibitor (BL-BLI) combination with broad antibacterial spectrum. The aim of this review is to describe the current and future role CAZ-AVI in the pediatric population with suspected or confirmed MDR-GN infections.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Maddalena Peghin
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessio Mesini
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elio Castagnola
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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11
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Xia G, Jiang R. Clinical study on the safety and efficacy of high-dose tigecycline in the elderly patients with multidrug-resistant bacterial infections: A retrospective analysis. Medicine (Baltimore) 2020; 99:e19466. [PMID: 32150105 PMCID: PMC7478498 DOI: 10.1097/md.0000000000019466] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Multidrug-resistant bacterial (MDRB) infections have been difficult to treat clinically. Tigecycline (TIG) has several advantages, especially in the treatment of severe infections. Many clinicians have considered increasing the TIG dose to improve the efficacy of this molecule. The safety and efficacy of high-dose TIG in elderly patients with MDRB infections were investigated in this study.We conducted a retrospective analysis of the elderly patients with MDRB infections who were treated at the First Affiliated Hospital. A total of 106 patients received a conventional dose (CD-TIG group: 50 mg every 12 hours) of TIG and 51 received a high dose (HD-TIG group: 100 mg every 12 hours). The data from all patients were collected for examining the clinical features and performing the microbiological analysis. The safety profile and efficacy of the HD regimen were investigated.The clinical efficacy and microbiological eradication in the patients with MDRB infection were higher in the HD-TIG group than the CD-TIG group. The independent predictors of clinical cure were the use of TIG at HD (odd ratio [OR], 5.129; 95% confidence interval [CI] [1.890, 13.921]; P = .001) and microbiological eradication (OR, 3.049; 95% CI, [1.251, 7.430]; P = .014). In the ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) subgroups, the sole independent predictor of clinical cure was the HD of TIG, and no significant adverse events were observed. The occurrence of multidrug-resistant Acinetobacter baumannii infection and an MIC value of 1 to 2 g/mL for TIG were independently associated with clinical failure in the VAP subgroup.HDs of TIG was found to associate with better clinical efficacy and microbiological eradication than its CDs in the elderly patients with MDRB infections. In the VAP and BSIs subgroups, administration of HDs of TIG was associated with better outcomes.
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12
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Chiotos K, Hayes M, Gerber JS, Tamma PD. Treatment of Carbapenem-Resistant Enterobacteriaceae Infections in Children. J Pediatric Infect Dis Soc 2020; 9:56-66. [PMID: 31872226 PMCID: PMC7047006 DOI: 10.1093/jpids/piz085] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/27/2019] [Indexed: 12/15/2022]
Abstract
Infections due to carbapenem-resistant Enterobacteriaceae (CRE) are increasingly prevalent in children and are associated with poor clinical outcomes. Optimal treatment strategies for CRE infections continue to evolve. A lack of pediatric-specific comparative effectiveness data, uncertain pediatric dosing regimens for several agents, and a relative lack of new antibiotics with pediatric indications approved by the US Food and Drug Administration (FDA) collectively present unique challenges for children. In this review, we provide a framework for antibiotic treatment of CRE infections in children, highlighting relevant microbiologic considerations and summarizing available data related to the evaluation of FDA-approved antibiotics (as of September 2019) with CRE activity, including carbapenems, ceftazidime-avibactam, meropenem-vaborbactam, imipenem/cilastatin-relebactam, polymyxins, tigecycline, eravacycline, and plazomicin.
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Affiliation(s)
- Kathleen Chiotos
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Antimicrobial Stewardship Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly Hayes
- Antimicrobial Stewardship Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Antimicrobial Stewardship Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pranita D Tamma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Carbapenem-Resistant Gram-Negative Bacterial Infections in Children. Antimicrob Agents Chemother 2020; 64:AAC.02183-19. [PMID: 31844014 DOI: 10.1128/aac.02183-19] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Carbapenem-resistant organisms (CRO) are a major global public health threat. Enterobacterales hydrolyze almost all β-lactams through carbapenemase production. Infections caused by CRO are challenging to treat due to the limited number of antimicrobial options. This leads to significant morbidity and mortality. Over the last few years, several new antibiotics effective against CRO have been approved. Some of them (e.g., plazomicin or imipenem-cilastatin-relebactam) are currently approved for use only by adults; others (e.g., ceftazidime-avibactam) have recently been approved for use by children. Recommendations for antibiotic therapy of CRO infections in pediatric patients are based on evidence mainly from adult studies. The availability of pediatric pharmacokinetic and safety data is the cornerstone to broaden the use of proposed agents in adults to the pediatric population. This article provides a comprehensive review of the current knowledge regarding infections caused by CRO with a focus on children, which includes epidemiology, risk factors, outcomes, and antimicrobial therapy management, with particular attention being given to new antibiotics.
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Chen F, Shen C, Pang X, Zhang Z, Deng Y, Han L, Chen X, Zhang J, Xia Q, Qian Y. Effectiveness of tigecycline in the treatment of infections caused by carbapenem-resistant gram-negative bacteria in pediatric liver transplant recipients: A retrospective study. Transpl Infect Dis 2019; 22:e13199. [PMID: 31627248 DOI: 10.1111/tid.13199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/22/2019] [Accepted: 10/12/2019] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- Fang Chen
- Department of Pharmacy, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chuan Shen
- Department of Liver Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyun Pang
- Department of Pharmacy, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zaili Zhang
- Department of Pharmacy, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuxiao Deng
- Department of Critical Care Medicine, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Longzhi Han
- Department of Liver Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaosong Chen
- Department of Liver Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Zhang
- Department of Liver Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yongbing Qian
- Department of Liver Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
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Resistant gram-negative infections in a pediatric intensive care unit: a retrospective study in a tertiary care center. Turk Arch Pediatr 2019; 54:105-112. [PMID: 31384145 PMCID: PMC6666360 DOI: 10.14744/turkpediatriars.2019.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 03/21/2019] [Indexed: 12/11/2022]
Abstract
Aim: Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital. Material and Methods: In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively. Results: One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1–205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobacter baumannii (n=28, 21.5%). Among A. baumannii isolates, the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance. Conclusion: Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.
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Safety and Efficacy of Tigecycline to Treat Multidrug-resistant Infections in Pediatrics: An Evidence Synthesis. Pediatr Infect Dis J 2019; 38:710-715. [PMID: 31192975 DOI: 10.1097/inf.0000000000002339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The need for antimicrobial therapies effective against multidrug resistant organisms for children remains unmet. Tigecycline shows antibacterial activity across a broad spectrum of bacteria and is approved for treating complicated skin and skin-structure infections, complicated intra-abdominal infections and, in the United States, community-acquired bacterial pneumonia for adult patients. No blinded, randomized phase 3 tigecycline clinical trials on neonates or children have been completed or planned. This review aimed to provide a comprehensive synthesis of all the existing data sources, both on-label and off-label, for tigecycline use in children. METHODS Data on tigecycline use in children were identified from published and unpublished sources including clinical trials, expanded access and compassionate use programs, databases of healthcare records and patient safety monitoring. RESULTS Pharmacokinetic simulations predicted that tigecycline 1.2 mg/kg (maximum dose 50 mg) every 12 hours (q12h) in children 8-11 years and 50 mg q12h in children 12 to <18 years would achieve exposure similar to adults receiving 50 mg q12h. Available phase 2 pediatric clinical trial data and data from other sources demonstrated similar clinical efficacy between adult and pediatric patients treated with tigecycline. These data showed no new or unexpected safety concerns with tigecycline in children. CONCLUSIONS Information presented here may help guide the appropriate use of tigecycline in children with multidrug resistant infections. Continued pharmacovigilance from real-world observational studies may also further refine appropriate use of tigecycline.
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Folgori L, Bielicki J. Future Challenges in Pediatric and Neonatal Sepsis: Emerging Pathogens and Antimicrobial Resistance. J Pediatr Intensive Care 2019; 8:17-24. [PMID: 31073504 DOI: 10.1055/s-0038-1677535] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/12/2018] [Indexed: 12/24/2022] Open
Abstract
The incidence of severe infections caused by multidrug-resistant (MDR) pathogens is currently rising worldwide, and increasing numbers of neonates and children with serious bloodstream infections due to resistant bacteria are being reported. Severe sepsis and septic shock due to gram-negative bacteria represent a significant cause of morbidity and mortality, and contribute to high health care costs. Antimicrobial resistance among Enterobacteriaceae represents a major problem in both health care-associated and community-acquired infections, with extended-spectrum β-lactamases (ESBLs) and carbapenem-resistant Enterobacteriaceae (CRE) now presenting the main threat. These infections in adult populations have been associated with poor clinical outcomes, but very limited data have been published so far about risk factors and clinical outcome of ESBL-associated and CRE sepsis in the pediatric population. The treatment of these infections in neonates and children is particularly challenging due to the limited number of available effective antimicrobials. Evidence-based use of new and older antibiotics based on both strategic and regulatory clinical trials is paramount to improve management of these severe infections in neonates and children.
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Affiliation(s)
- Laura Folgori
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Julia Bielicki
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom.,Department of Paediatric Pharmacology, University Children's Hospital Basel, Basel, Switzerland
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18
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Preliminary experience with tigecycline treatment for severe infection in children. Eur J Pediatr 2018; 177:1489-1496. [PMID: 30008076 DOI: 10.1007/s00431-018-3208-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/02/2018] [Accepted: 07/09/2018] [Indexed: 02/01/2023]
Abstract
Severe infection is a primary cause of mortality in children facing challenges from multidrug-resistant (MDR) pathogens, particularly MDR Acinetobacter baumannii. Tigecycline has an expanded spectrum of antibacterial activity, and some successful instances of its use in children have been reported. We conducted a retrospective chart review of children treated at a tertiary hospital between May 1, 2012 and May 1, 2017 to examine the efficacy and safety of tigecycline in children with severe infection. A total of 110 patients (69 males) were enrolled in this study, including 46 MDR A. baumannii infection patients, encompassing 51 A. baumannii strains. Totally, the median duration of tigecycline therapy was 10 days (range, 2-47 days), with a clinical improvement rate of 47.27% (52/110). In A. baumannii infection group, the clinical improvement rate was 50% (23/46) and the microbiology eradication rate was 50.98% (26/51). No adverse events were reported during therapy; however, in one case, a 9-year-old boy with hematologic disease developed tooth discoloration.Conclusion: Although some patients benefited from tigecycline, the efficacy and safety of tigecycline should not be overvalued. Additional data from randomized controlled trials are required to assess the administration of tigecycline. What is Known: • Severe infection is a primary cause of mortality in pediatric patients and its treatment is facing challenges from an increasing number of multidrug-resistant (MDR) pathogens. • Tigecycline has an expanded spectrum of antibacterial activity. • Several case reports have indicated that tigecycline could be used as a salvage therapy in children when options are limited or non-existent. What is New: • We found that rate of clinical improvement was different in various groups of different infection. The efficacy of tigecycline should not be overvalued. • Six dosage models and different infection types were observed in our series, with different improvement and eradication rate, indicating that more data are required to identify a proper tigecycline dosage.
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Song Y, Hu L, Shu Q, Ye J, Liang J, Chen X, Tan L. Tigecycline salvage therapy for critically ill children with multidrug-resistant/extensively drug-resistant infections after surgery. Int J Infect Dis 2018; 75:82-88. [PMID: 30125690 DOI: 10.1016/j.ijid.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/25/2018] [Accepted: 08/07/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and safety of salvage therapy of tigecycline in critically ill children with infections caused by multidrug-resistant (MDR)/extensively drug-resistant (XDR) bacteria after surgery. METHODS A retrospective chart review was performed of critically ill children after surgery who had received tigecycline for ≥3days between June 2012 and May 2016 in the surgical intensive care unit of a tertiary level children's hospital. RESULTS Of 6442 consecutive children admitted after surgery, a total of 22 were enrolled. They had a median age of 7.5 months (interquartile range (IQR), 6 months to 4 years) and a median weight of 7.3kg (IQR, 5.1-12.5kg). Patients received tigecycline for a median 17days (IQR, 12-20 days). The median intensive care unit stay was 56days (IQR, 38-61 days) and median hospital stay was 78days (IQR, 61-94 days). Tigecycline was prescribed as culture-directed therapy in 91% of patients and as empirical therapy in 9%. Clinical success was reported in 86% of the patients. The all-cause mortality in this cohort was 18%. No serious adverse effects of tigecycline were detected in these patients. CONCLUSIONS Tigecycline salvage therapy was successful in 86% of critically ill pediatric patients with MDR/XDR infections after surgery, with no severe adverse effects.
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Affiliation(s)
- Ying Song
- Department of Surgical ICU, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lei Hu
- Department of Surgical ICU, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Shu
- Department of Cardiac Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Ye
- Department of Surgical ICU, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianfeng Liang
- Department of Medical Statistics, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xi Chen
- Key Laboratory of Diagnosis and Treatment of Neonatal Diseases of Zhejiang Province, Hangzhou, China; Department of Central Laboratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linhua Tan
- Department of Surgical ICU, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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20
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Lin S, Zhang C, Ye S. Preliminary experience of tigecycline treatment for infection in children with hematologic malignancies. Int J Clin Pharm 2018; 40:1030-1036. [PMID: 30051224 DOI: 10.1007/s11096-018-0690-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022]
Abstract
Background Severe infection is life-threatening in children with hematologic malignancies and its treatment is challenging because of an increasing number of multidrug-resistant pathogens. Tigecycline has an expanded antibacterial activity spectrum; some successful cases of tigecycline treatment have been reported in the literature. Objective To examine the efficacy and safety of tigecycline in children. Setting Department of hematologic malignancies in a tertiary hospital. Method A retrospective chart review from May 1, 2012 to May 1, 2017. The patients were identified by the hospital information system and a custom-made Microsoft Excel 2007 database of patients was created to record demographic and medical data. Main outcome measure Efficacy and safety of tigecycline use in severe infection children with hematologic malignancies. Results Thirty-seven patients were enrolled and the predominant diagnosis was acute lymphoblastic leukemia. The median duration of tigecycline therapy was 9 days. Most prescriptions were empirical. Eighteen patients received a maintenance dose of 2 mg/kg q12 h, without a loading dose. Sulperazone was the most frequently prescribed concomitant drug. At the end of tigecycline therapy, improvement was observed in 48.7% of cases. After treatment, interleukin-10 levels notably decreased. The only reported adverse event was a case of tooth discoloration. Conclusion Tigecycline can be used as salvage therapy in children with hematologic malignancy and seems tolerable. Prospective controlled studies are required to definitively evaluate the efficacy and safety of tigecycline in children.
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Affiliation(s)
- Shupeng Lin
- Division of Hematology-Oncology, Children's Hospital Zhejiang University School of Medicine, No. 57, Zhugan Road, Hangzhou, 310003, China
| | - Chenmei Zhang
- Department of Pediatric Intensive Care Unit, Children's Hospital Zhejiang University School of Medicine, No. 3333, Binsheng Road, Hangzhou, 310052, China
| | - Sheng Ye
- Department of Pediatric Intensive Care Unit, Children's Hospital Zhejiang University School of Medicine, No. 3333, Binsheng Road, Hangzhou, 310052, China.
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21
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Chronic otitis media caused by Mycobacterium abscessus spp. massiliense treated with tigecycline in a 10-year-old child. Int J Infect Dis 2018; 74:10-12. [PMID: 29966711 DOI: 10.1016/j.ijid.2018.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022] Open
Abstract
Mycobacterium abscessus is one of the most pathogenic and chemotherapy-resistant rapidly growing mycobacteria. This Mycobacterium should always be considered as a possible cause of chronic otitis media in children, and treatment might be challenging because of its resistance to multiple antibiotics. There are no reports describing the therapeutic use of tigecycline for the treatment of chronic otitis media caused by M. abscessus. A 10-year-old boy was referred to Tokyo Metropolitan Children's Medical Center with a 7-year history of recurrent otitis media despite treatment with antibiotics and ventilation tubes. Cultures of the otorrhea yielded Mycobacterium abscessus spp. massiliense, and it showed multiple and high-level resistance. The boy required surgery and underwent initial treatment with clarithromycin, amikacin, and tigecycline for 4 weeks. He experienced emesis as a side-effect of tigecycline, which was well controlled with ondansetron. He was treated successfully with 3 months of subsequent oral clarithromycin and linezolid. This is the first pediatric case of chronic otitis media caused by M. abscessus treated with a tigecycline-containing regimen. Although the therapeutic use of tigecycline remains controversial, especially in the pediatric population, it can be an acceptable option in the treatment of chronic otitis media caused by M. abscessus.
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Lin S, Liang L, Zhang C, Ye S. Preliminary experience of tigecycline treatment in critically ill children with ventilator-associated pneumonia. J Int Med Res 2018; 48:300060518760435. [PMID: 29614915 PMCID: PMC7113491 DOI: 10.1177/0300060518760435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Ventilator-associated pneumonia (VAP) is a life-threatening complication for
children who are treated in a paediatric intensive care unit. Tigecycline
treatment of children with VAP has not been well studied. This study aimed
to describe tigecycline use in children with VAP in a tertiary care
hospital. Methods We conducted a retrospective chart review in a tertiary hospital from May 1,
2012 to May 1, 2017. Results Twenty-four children (20 girls) with median age of 8 months (range, 27 days
to 6 years and 9 months) were treated with tigecycline. In-hospital
mortality was 41.7% (10/24). The primary diagnosis was congenital heart
disease (15/24). A total of 70.8% (17/24) of patients received a loading
dose (1.5 mg/kg), followed by 1 mg/kg every 12 hours. The median duration of
tigecycline therapy was 10.75 days (range, 3–21.5 days). Sulperazone was the
most frequently used concomitant antibiotic. Eighteen pathogens were
isolated in 16 cases. Tigecycline therapy failed in 41.6% (10/24) of
patients and 20.8% (5/24) died. The pathogen was eradicated in 37.5% (6/16)
of patients. No serious adverse effects were detected. Conclusion Tigecycline combined with other agents as salvage therapy in children with
VAP is well tolerated. Our preliminary results show a positive clinical
response.
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Affiliation(s)
- Shupeng Lin
- 37066 Zhejiang University School of Medicine Children's Hospital , Division of Hematology- Oncology, No. 57 Zhugan Road, Hangzhou, CN 310052
| | - Lingfang Liang
- 37066 Zhejiang University School of Medicine Children's Hospital , Pediatric Intensive Care Unit, No. 3333 Binsheng Road, Hangzhou, CN 310003
| | - Chenmei Zhang
- 37066 Zhejiang University School of Medicine Children's Hospital , Pediatric Intensive Care Unit, No. 3333 Binsheng Road, Hangzhou, CN 310003
| | - Sheng Ye
- 37066 Zhejiang University School of Medicine Children's Hospital , Pediatric Intensive Care Unit, No. 3333 Binsheng Road, Hangzhou, CN 310003
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Iosifidis E, Violaki A, Michalopoulou E, Volakli E, Diamanti E, Koliouskas D, Antachopoulos C, Drossou-Agakidou V, Sdougka M, Roilides E. Use of Tigecycline in Pediatric Patients With Infections Predominantly Due to Extensively Drug-Resistant Gram-Negative Bacteria. J Pediatric Infect Dis Soc 2017; 6:123-128. [PMID: 27000866 DOI: 10.1093/jpids/piw009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/09/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND. Emergence of extensively drug-resistant (XDR) bacteria has forced clinicians to use off-label antimicrobial agents such as tigecycline. We present our experience on salvage use of tigecycline for the treatment of infections caused by XDR Gram-negative bacteria in critically ill children and review published cases. METHODS. We conducted a retrospective chart review in pediatric departments of a tertiary level hospital from January 2009 to May 2014. Patients were identified using pharmacy database. For the literature review, relevant articles were identified from PubMed. RESULTS. In our case series, 13 children (7 males) with a median age of 8 years (range, 2.5 months-14 years) received tigecycline for ≥2 days as treatment for healthcare-associated infections including 5 bacteremias, 6 lower respiratory tract infections, and 3 other infections. Isolated pathogens were XDR Gram-negative bacteria except 1. A loading dose (range, 1.8-6.5 mg/kg) was given in all except 2 cases. Maintenance dose was given at 1-3.2 mg/kg q12 h. Other antimicrobials including colistin and aminoglycosides (85% and 62%, respectively) were coadministered to all patients. No serious adverse events were detected in these very ill children. Twenty cases of children treated with tigecycline were previously published, mostly for multidrug-resistant/XDR bacteria. An episode of acute pancreatitis and neutrophil engraftment delay in 2 cases were reported during tigecycline treatment. Analyzing reported and all our cases together, mortality in bloodstream infections was 86%, whereas in nonbacteremic cases it was 24% (P = .009). CONCLUSIONS. Tigecycline, given at the range of administered doses as salvage therapy and in combination with other antimicrobial agents, seemed to be well tolerated in a series of mainly critically ill pediatric patients and demonstrated relatively good clinical response in nonbacteremic patients.
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Affiliation(s)
| | | | | | | | - Elisavet Diamanti
- 1st Department of Neonatology and Neonatal Intensive Care Unit, Medical Faculty, Aristotle University School of Health Sciences, and
| | | | | | - Vasiliki Drossou-Agakidou
- 1st Department of Neonatology and Neonatal Intensive Care Unit, Medical Faculty, Aristotle University School of Health Sciences, and
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Clinical and Bacterial Risk Factors for Mortality in Children With Carbapenem-resistant Enterobacteriaceae Bloodstream Infections in India. Pediatr Infect Dis J 2017; 36:e161-e166. [PMID: 28005691 DOI: 10.1097/inf.0000000000001499] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) are an increasing cause of nosocomial infection in hospitalized children worldwide. Few studies have investigated risk factors for mortality in children with CRE bloodstream infection (BSI). Data are particularly scarce in areas where NDM and OXA carbapenemases predominate. Here, we investigate mortality rates, clinical and microbiologic risk factors for mortality in 50 pediatric patients with CRE BSI in India. METHODS Children younger than 17 years old with meropenem-resistant Klebsiella pneumoniae or Escherichia coli isolated from blood culture in 2014 and 2015 were identified from laboratory records. Clinical records were systematically reviewed for each child to establish mortality at 30 days and clinical details. Bacterial isolates were subjected to meropenem E test and multiplex polymerase chain reaction to determine carbapenemase gene. Data were analyzed to establish clinical and bacterial risk factors for mortality. RESULTS All CRE BSI were hospital-acquired or associated with healthcare. A total of 84% of children had an underlying comorbidity and 46% had a malignancy. K. pneumoniae was the most common bacteria isolated; NDM was the most common carbapenemase gene detected. The mortality rate was 52%. Significant risk factors for mortality included intensive care admission, intubation, inotropic support and respiratory source. Failure to clear bacteremia and a minimum inhibitory concentration > 8 mg/L for the isolate was associated with a statistically significant increase in mortality. Mortality rates were significantly lower when two or more effective drugs were used in combination. CONCLUSIONS CRE BSI affects children with multiple comorbidities and repeated admissions to hospital. The mortality rate is high; combination therapy may be beneficial.
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Zeng J, Zhang L, Gao M, Wu J, Wu H, Chen J, Chen X, Tang W. Tigecycline treatment in an infant with extensively drug-resistant Acinetobacter baumannii bacteremia. Int J Infect Dis 2017; 61:23-26. [PMID: 28572073 DOI: 10.1016/j.ijid.2017.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/18/2017] [Accepted: 05/20/2017] [Indexed: 11/27/2022] Open
Abstract
The successful use of tigecycline in a 12-month old liver transplant recipient with extensively drug-resistant Acinetobacter baumannii bacteremia is presented. Tigecycline serum concentrations were monitored to help improve antibiotic efficacy and minimize side effects. A literature review identified 11 additional pediatric cases of A. baumannii infection treated with tigecycline since 2011. Tigecycline treatment should be considered in children with extensively drug-resistant bacterial infections.
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Affiliation(s)
- Jiawei Zeng
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Lidan Zhang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Min Gao
- Department of Pharmacy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Jingjing Wu
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Haiyan Wu
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jie Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wen Tang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
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Mastrolia MV, Galli L, De Martino M, Chiappini E. Use of tigecycline in pediatric clinical practice. Expert Rev Anti Infect Ther 2017; 15:605-612. [PMID: 28395551 DOI: 10.1080/14787210.2017.1318064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Tigecycline, a derivative of minocycline, is an extended-spectrum antimicrobial agent. It has a restricted approval field in children and the experience of its adoption in clinical practice is reserved for cases of challenging infections. The aim of this review was to summarize evidence regarding the use of tigecycline in infants and children, focusing on the drug's clinical efficacy data and tolerability profile. Areas covered: We have conducted a literature search of the Cochrane Library, EMBASE, and MEDLINE databases, from their inception through 5 January 2017, using the following terms: tigecycline, newborn, infant, child, pediatrics, adolescent, human, clinical trial, and case report. Articles were excluded if they were redundant or not pertinent. Bibliographies of all relevant articles were also evaluated. Seventeen publications were included: 1 pharmacokinetic study, 16 case reports. In the selected publications, the patients' mean age was 4.45 years, 38.7% of children was <3 years old and favorable clinical response was achieved in 74.2% of cases. Expert commentary: Tigecycline may be a considerable option in life-threatening infections in pediatric patients. Its administration is well tolerated and has demonstrated a good clinical response in nonbacteremic patients. However, the available clinical records are limited and more studies are needed.
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Affiliation(s)
- Maria Vincenza Mastrolia
- a Pediatric Infectious Disease Unit , Anna Meyer Children's University Hospital , Florence , Italy
| | - Luisa Galli
- a Pediatric Infectious Disease Unit , Anna Meyer Children's University Hospital , Florence , Italy
| | - Maurizio De Martino
- a Pediatric Infectious Disease Unit , Anna Meyer Children's University Hospital , Florence , Italy
| | - Elena Chiappini
- a Pediatric Infectious Disease Unit , Anna Meyer Children's University Hospital , Florence , Italy
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Zhu ZY, Yang JF, Ni YH, Ye WF, Wang J, Wu ML. Retrospective analysis of tigecycline shows that it may be an option for children with severe infections. Acta Paediatr 2016; 105:e480-4. [PMID: 27381360 DOI: 10.1111/apa.13516] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/07/2016] [Accepted: 07/04/2016] [Indexed: 02/02/2023]
Abstract
AIM This study assessed the efficacy and safety of tigecycline in children with life-threatening infections. METHODS We retrospectively reviewed the clinical records of patients treated with tigecycline from June 2012 to May 2014 in a Chinese tertiary centre. RESULTS The study comprised 24 patients (14 male) with a median age of four years (range, 50 days-12 years). The most frequently isolated microorganism, most common isolation site and type of infection were Acinetobacter baumannii, tracheal aspirate fluid and ventilator-associated pneumonia, respectively. Tigecycline was administered at a loading dose of 1.5 or 2.0 mg/kg and 1.0 mg/kg every 12 hours after that. The average duration of treatment was 11.6 ± 5.8 days. The clinical response and microbiological eradication rate were 37.5% and 29.2%, respectively. Six of the patients we studied (25.0%) died, and three of these deaths were considered to be infection related. Adverse drug reactions were identified in four patients (16.7%) during the treatment, including abnormal liver function, prolonged prothrombin time and diarrhoea. CONCLUSION Our findings suggest that tigecycline may be an option for children with severe infections. However, more prospective, controlled trials are required to objectively evaluate the efficacy and safety of tigecycline in children.
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Affiliation(s)
- Zheng-Yi Zhu
- Department of Pharmacy; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - Ju-Fei Yang
- Department of Pharmacy; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - Ying-Hua Ni
- Department of Pharmacy; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - Wei-Feng Ye
- Department of Pharmacy; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - Jue Wang
- Department of Pharmacy; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - Miao-Lian Wu
- Department of Pharmacy; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
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Xu L, Wang YL, Du S, Chen L, Long LH, Wu Y. Efficacy and Safety of Tigecycline for Patients with Hospital-Acquired Pneumonia. Chemotherapy 2016; 61:323-30. [PMID: 27144279 DOI: 10.1159/000445425] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/12/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tigecycline is an antibiotic agent with a broad spectrum, which has an antibacterial effect against many multidrug-resistant organisms. However, its clinical efficacy in the treatment of hospital-acquired pneumonia (HAP) is disputed. MATERIALS AND METHODS In this report, a systematic review and meta-analysis were conducted to evaluate the efficacy and safety of tigecycline for the treatment of HAP. The primary outcome was the rate of clinical cure, and the secondary outcomes were mortality and adverse events (AEs). RESULTS Four trials involving 1,234 patients were included. The standard-dose tigecycline and comparator groups did not differ significantly in their rates of clinical cure. However, high-dose tigecycline was more effective than standard-dose tigecycline or the comparators for the treatment of HAP. There was no significant difference in mortality between the standard-dose or high-dose regimen and the comparators. Although the safety profile of standard-dose tigecycline was similar to the comparators, the high-dose regimen exhibited more AEs compared with the other groups. CONCLUSION High-dose tigecycline is efficient for the treatment of HAP but is associated with more AEs.
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de Sá Del Fiol F, Barberato-Filho S, de Cássia Bergamaschi C, Lopes LC, Gauthier TP. Antibiotics and Breastfeeding. Chemotherapy 2016; 61:134-43. [PMID: 26780532 DOI: 10.1159/000442408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022]
Abstract
During the breastfeeding period, bacterial infections can occur in the nursing mother, requiring the use of antibiotics. A lack of accurate information may lead health care professionals and mothers to suspend breastfeeding, which may be unnecessary. This article provides information on the main antibiotics that are appropriate for clinical use and the interference of these antibiotics with the infant to support medical decisions regarding the discontinuation of breastfeeding. We aim to provide information on the pharmacokinetic factors that interfere with the passage of antibiotics into breast milk and the toxicological implications of absorption by the infant. Publications related to the 20 most frequently employed antibiotics and their transfer into breast milk were evaluated. The results demonstrate that most antibiotics in clinical use are considered suitable during breastfeeding; however, the pharmacokinetic profile of each drug must be observed to ensure the resolution of the maternal infection and the safety of the infant.
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Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging global public health threat. Infections due to CRE are associated with significant morbidity and mortality. Few therapeutic options are available for treatment of these infections, and optimal antibiotic treatment regimens are unclear. Along with the rapidly increasing prevalence of CRE in the USA and worldwide, several studies have described the epidemiology of CRE in the adult population. While CRE are now also reported sporadically in children, there is a significant lack of data on the epidemiology, risk factors, treatment, and outcomes in this population. This article provides a comprehensive review of what is known to date about CRE, including clinical and molecular epidemiology, microbiologic diagnosis, antibiotic treatment options, and outcomes. In particular, this review will focus on the available data on CRE in the pediatric population.
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Affiliation(s)
- Kathleen Chiotos
- Division of Critical Care, Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Abramson Research Building, Room 1202, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Jennifer H Han
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 811 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Pranita D Tamma
- Division of Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, 200 North Wolfe Street, Suite 3149, Baltimore, MD, 21287, USA.
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An in vitro combined antibiotic-antibody treatment eliminates toxicity from Shiga toxin-producing Escherichia coli. Antimicrob Agents Chemother 2015; 59:5435-44. [PMID: 26100707 DOI: 10.1128/aac.00763-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/16/2015] [Indexed: 12/11/2022] Open
Abstract
Treating Shiga toxin-producing Escherichia coli (STEC) gastrointestinal infections is difficult. The utility of antibiotics for STEC treatment is controversial, since antibiotic resistance among STEC isolates is widespread and certain antibiotics dramatically increase the expression of Shiga toxins (Stxs), which are some of the most important virulence factors in STEC. Stxs contribute to life-threatening hemolytic uremic syndrome (HUS), which develops in considerable proportions of patients with STEC infections. Understanding the antibiotic resistance profiles of STEC isolates and the Stx induction potential of promising antibiotics is essential for evaluating any antibiotic treatment of STEC. In this study, 42 O157:H7 or non-O157 STEC isolates (including the "big six" serotypes) were evaluated for their resistance against 22 antibiotics by using an antibiotic array. Tigecycline inhibited the growth of all of the tested STEC isolates and also inhibited the production of Stxs (Stx2 in particular). In combination with neutralizing antibodies to Stx1 and Stx2, the tigecycline-antibody treatment fully protected Vero cells from Stx toxicity, even when the STEC bacteria and the Vero cells were cultured together. The combination of an antibiotic such as tigecycline with neutralizing antibodies presents a promising strategy for future STEC treatments.
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Molloy L, Arora H, Gupta S, Sutton J, Abdel-Haq N. Multidrug-Resistant Organisms: Considerations in Antibiotic Selection and Administration. J Pediatr Intensive Care 2015; 4:87-96. [PMID: 31110857 PMCID: PMC6513150 DOI: 10.1055/s-0035-1556751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/02/2014] [Indexed: 10/23/2022] Open
Abstract
Managing infections caused by multidrug-resistant organisms is a significant clinical challenge. Multidrug-resistant organisms' treatment is complicated in the pediatric population because of the lack of primary data, treatment guidelines, rapidly changing pharmacokinetic/pharmacodynamic parameters, and fewer approved antibiotic indications and dosing guidance. Treatment decisions must incorporate available pediatric data, clinical experience, and careful extrapolation from adult data while considering the unique challenges faced by children with complicated infections.
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Affiliation(s)
- Leah Molloy
- Department of Pharmacy, Children's Hospital of Michigan, Detroit, Michigan, United States
| | - Harbir Arora
- Division of Infectious Diseases, Children's Hospital of Michigan, Detroit, Michigan, United States
| | - Shipra Gupta
- Division of Infectious Diseases, Children's Hospital of Michigan, Detroit, Michigan, United States
| | - Jesse Sutton
- Department of Pharmacy, Baptist Health Louisville, Louisville, Kentucky, United States
| | - Nahed Abdel-Haq
- Division of Infectious Diseases, Children's Hospital of Michigan, Detroit, Michigan, United States
- Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan, United States
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Global assessment of antimicrobial susceptibility among Gram-negative organisms collected from pediatric patients between 2004 and 2012: results from the Tigecycline Evaluation and Surveillance Trial. J Clin Microbiol 2015; 53:1286-93. [PMID: 25653413 DOI: 10.1128/jcm.03184-14] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The Tigecycline Evaluation and Surveillance Trial (TEST) was designed to monitor susceptibility to commonly used antimicrobial agents among important pathogens. We report here on susceptibility among Gram-negative pathogens collected globally from pediatric patients between 2004 and 2012. Antimicrobial susceptibility was determined using guidelines published by the Clinical and Laboratory Standards Institute (CLSI). Most Enterobacteriaceae showed high rates of susceptibility (>95%) to amikacin, tigecycline, and the carbapenems (imipenem and meropenem); 90.8% of Acinetobacter baumannii isolates were susceptible to minocycline, and susceptibility rates were highest in North America, Europe, and Asia/Pacific Rim. Amikacin was the most active agent against Pseudomonas aeruginosa (90.4% susceptibility), with susceptibility rates being highest in North America. Extended-spectrum β-lactamases (ESBLs) were reported for 11.0% of Escherichia coli isolates and 24.2% of Klebsiella pneumoniae isolates globally, with rates reaching as high as 25.7% in the Middle East and >43% in Africa and Latin America, respectively. Statistically significant (P<0.01) differences in susceptibility rates were noted between pediatric age groups (1 to 5 years, 6 to 12 years, or 13 to 17 years of age), globally and in some regions, for all pathogens except Haemophilus influenzae. Significant (P<0.01) differences were reported for all pathogens globally and in most regions, considerably more frequently, when pediatric and adult susceptibility results were compared. Amikacin, tigecycline, and the carbapenems were active in vitro against most Gram-negative pathogens collected from pediatric patients; A. baumannii and P. aeruginosa were susceptible to fewer antimicrobial agents. Susceptibility rates among isolates from pediatric patients were frequently different from those among isolates collected from adults.
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Abstract
INTRODUCTION The emergence of multidrug-resistant (MDR) infections has been extensively observed worldwide and has become a priority issue over past decade. Tigecycline , a broad spectrum antibiotic covering against many MDR organisms, has been widely used. However, recent meta-analysis studies have raised a concern for its efficacy and safety. Reviewing tigecycline safety data would enhance the appropriate use of this medication. AREAS COVERED This article reviews the safety profile of tigecycline, including its side effects and drug interactions. EXPERT OPINION The increased mortality associated with tigecycline is not yet well understood. Based on current evidence, alternative options must be prioritized over tigecycline if available. When tigecycline use is warranted, vigilant observation to identify any breakthrough infections and careful monitoring of progression of the original infection are highly recommended. Considering a second agent (either for synergism or enhancing coverage) may be required.
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Affiliation(s)
- Quanhathai Kaewpoowat
- University of Texas Health Science Center at Houston, Division of Infectious Diseases , 6431 Fannin Street, MSB 2.112, Houston, TX 77030 , USA +1 713 500 6733 ; +1 713 500 5495 ;
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Lutsar I, Telling K, Metsvaht T. Treatment option for sepsis in children in the era of antibiotic resistance. Expert Rev Anti Infect Ther 2014; 12:1237-52. [PMID: 25189378 DOI: 10.1586/14787210.2014.956093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sepsis caused by multidrug-resistant microorganisms is one of the most serious infectious diseases of childhood and poses significant challenges for pediatricians involved in management of critically ill children. This review discusses the use of pharmacokinetic/dynamic principles (i.e., prolonged infusion of β-lactams and vancomycin, once-daily administration of aminoglycosides and rationale of therapeutic drug monitoring) when prescribing antibiotics to critically ill patients. The potential of 'old' agents (i.e., colistin, fosfomycin) and newly approved antibiotics is critically reviewed. The pros and cons of combination antibacterial therapy are discussed and finally suggestions for the treatment of sepsis caused by multidrug-resistant organisms are provided.
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Affiliation(s)
- Irja Lutsar
- Institute of Medical Microbiology, University of Tartu, Ravila 19, 50411 Tartu, Estonia
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36
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Gonzalez D, Paul IM, Benjamin DK, Cohen-Wolkowiez M. Advances in pediatric pharmacology, therapeutics, and toxicology. Adv Pediatr 2014; 61:7-31. [PMID: 25037123 PMCID: PMC4120955 DOI: 10.1016/j.yapd.2014.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the United States, passage of the FDASIA legislation made BPCA and PREA permanent, no longer requiring reauthorization every 5 years. This landmark legislation also stressed the importance of performing clinical trials in neonates when appropriate. In Europe the Pediatric Regulation, which went into effect in early 2007, also provides a framework for expanding pediatric clinical research. Although much work remains, as a result of greater regulatory guidance more pediatric data are reaching product labels.
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Affiliation(s)
- Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 301 Pharmacy Lane, Chapel Hill, NC 27599, USA; Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA
| | - Ian M Paul
- Department of Pediatrics, College of Medicine, Penn State University, 500 University Drive, HS83, Hershey, PA 17033, USA; Department of Public Health Sciences, College of Medicine, Penn State University, 500 University Drive, HS83, Hershey, PA 17033, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA; Department of Pediatrics, College of Medicine, Duke University, T901/Children's Health Center, Durham, NC 27705, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA; Department of Pediatrics, College of Medicine, Duke University, T901/Children's Health Center, Durham, NC 27705, USA.
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37
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De Pascale G, Montini L, Pennisi M, Bernini V, Maviglia R, Bello G, Spanu T, Tumbarello M, Antonelli M. High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R90. [PMID: 24887101 PMCID: PMC4057423 DOI: 10.1186/cc13858] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/24/2014] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The high incidence of multidrug-resistant (MDR) bacteria among patients admitted to ICUs has determined an increase of tigecycline (TGC) use for the treatment of severe infections. Many concerns have been raised about the efficacy of this molecule and increased dosages have been proposed. Our purpose is to investigate TGC safety and efficacy at higher than standard doses. METHODS We conducted a retrospective study of prospectively collected data in the ICU of a teaching hospital in Rome. Data from all patients treated with TGC for a microbiologically confirmed infection were analyzed. The safety profile and efficacy of high dosing regimen use were investigated. RESULTS Over the study period, 54 patients (pts) received TGC at a standard dose (SD group: 50 mg every 12 hours) and 46 at a high dose (HD group: 100 mg every 12 hours). Carbapenem-resistant Acinetobacter.baumannii (blaOXA-58 and blaOXA-23 genes) and Klebsiella pneumoniae (blaKPC-3 gene) were the main isolated pathogens (n = 79). There were no patients requiring TGC discontinuation or dose reduction because of adverse events. In the ventilation-associated pneumonia population (VAP) subgroup (63 patients: 30 received SD and 33 HD), the only independent predictor of clinical cure was the use of high tigecycline dose (odds ratio (OR) 6.25; 95% confidence interval (CI) 1.59 to 24.57; P = 0.009) whilst initial inadequate antimicrobial treatment (IIAT) (OR 0.18; 95% CI 0.05 to 0.68; P = 0.01) and higher Sequential Organ Failure Assessment (SOFA) score (OR 0.66; 95% CI 0.51 to 0.87; P = 0.003) were independently associated with clinical failure. CONCLUSIONS TGC was well tolerated at a higher than standard dose in a cohort of critically ill patients with severe infections. In the VAP subgroup the high-dose regimen was associated with better outcomes than conventional administration due to Gram-negative MDR bacteria.
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Gostelow M, Gonzalez D, Smith PB, Cohen-Wolkowiez M. Pharmacokinetics and safety of recently approved drugs used to treat methicillin-resistant Staphylococcus aureus infections in infants, children and adults. Expert Rev Clin Pharmacol 2014; 7:327-40. [PMID: 24716805 PMCID: PMC4032771 DOI: 10.1586/17512433.2014.909281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant cause of morbidity in hospitalized infants. Over the past 15 years, several drugs have been approved for the treatment of S. aureus infections in adults (linezolid, quinupristin/dalfopristin, daptomycin, telavancin, tigecycline and ceftaroline). The use of the majority of these drugs has extended into the treatment of MRSA infections in infants, frequently with minimal safety or dosing information. Only linezolid is approved for use in infants, and pharmacokinetic data in infants are limited to linezolid and daptomycin. Pediatric trials are underway for ceftaroline, telavancin, and daptomycin; however, none of these studies includes infants. Here, we review current pharmacokinetic, safety and efficacy data of these drugs with a specific focus in infants.
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Affiliation(s)
- Martyn Gostelow
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Daniel Gonzalez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P. Brian Smith
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
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Gwee A, Cranswick N. Anti-infective use in children and pregnancy: current deficiencies and future challenges. Br J Clin Pharmacol 2014; 79:216-21. [PMID: 24588467 DOI: 10.1111/bcp.12363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/11/2014] [Indexed: 12/20/2022] Open
Abstract
There are a number of challenges to using anti-infective agents in children and pregnant women. There is limited understanding of the altered pharmacokinetics of anti-infectives in these populations and as a result, optimized dosing regimens are yet to be established. The potential adverse effects of the drug on pregnancy outcome and the developing foetus is a major consideration, and the long term implications of drug side effects must be taken into account when drug exposure occurs early in life. These factors hinder research and licensing of new anti-infective drugs in these populations. We describe the current deficiencies and future challenges of anti-infective use in children and pregnant women, providing specific examples.
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Affiliation(s)
- Amanda Gwee
- Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria; Murdoch Childrens Research Institute, Melbourne, Victoria
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40
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Hsu AJ, Tamma PD. Treatment of multidrug-resistant Gram-negative infections in children. Clin Infect Dis 2014; 58:1439-48. [PMID: 24501388 DOI: 10.1093/cid/ciu069] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Antibiotic resistance in conjunction with the erosion of the drug development pipeline may lead us into a bleak future, a "post-antibiotic era." Because of a shortage of studies addressing treatment options for multidrug-resistant Gram-negative (MDRGN) infections in children, data must be extrapolated from the adult literature. However, even adult studies are limited by significant methodological flaws. We are in urgent need of pediatric specific pharmacokinetic/pharmacodynamic data for agents with activity against MDRGN infections as well as improved clinical outcomes studies. For the time being, we must rely on in vitro studies, observational data, and clinical experience to guide our therapeutic decisions. In this review, we discuss treatment considerations for infections caused by extended-spectrum β-lactamase-producing organisms, AmpC β-lactamase-producing organisms, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii in the pediatric population.
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Affiliation(s)
- Alice J Hsu
- Department of Pharmacy, Division of Pediatric Pharmacy, The Johns Hopkins Hospital
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41
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Galli L, Montagnani C, Chiappini E, de Martino M. Treating paediatric community-acquired pneumonia in the era of antimicrobial resistance. Acta Paediatr 2013; 102:25-33. [PMID: 24330270 DOI: 10.1111/apa.12503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
UNLABELLED Increasing levels of paediatric community-acquired pneumonia (CAP), caused by drug-resistant bacteria and antimicrobial resistance, vary with age and countries and, in some cases, serotypes. When empirical first-line treatment administration fails, paediatricians should consider second-line treatments based on the prevalence of local resistance. A more judicious use of antimicrobial agents is also required. CONCLUSION Knowledge of local epidemiology and an appropriate use of antimicrobial drugs are necessary to treat CAP in this era of antimicrobial resistance.
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Affiliation(s)
- L Galli
- Department of Health Sciences; University of Florence; Anna Meyer Children's University-Hospital; Florence Italy
| | - C Montagnani
- Department of Health Sciences; University of Florence; Anna Meyer Children's University-Hospital; Florence Italy
| | - E Chiappini
- Department of Health Sciences; University of Florence; Anna Meyer Children's University-Hospital; Florence Italy
| | - M de Martino
- Department of Health Sciences; University of Florence; Anna Meyer Children's University-Hospital; Florence Italy
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Garazzino S, Lutsar I, Bertaina C, Tovo PA, Sharland M. New antibiotics for paediatric use: A review of a decade of regulatory trials submitted to the European Medicines Agency from 2000—Why aren’t we doing better? Int J Antimicrob Agents 2013; 42:99-118. [DOI: 10.1016/j.ijantimicag.2013.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
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Antimicrobial susceptibility among Gram-positive organisms collected from pediatric patients globally between 2004 and 2011: results from the Tigecycline Evaluation and Surveillance Trial. J Clin Microbiol 2013; 51:2371-8. [PMID: 23678070 DOI: 10.1128/jcm.00157-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Tigecycline Evaluation and Surveillance Trial (TEST) was designed to monitor global longitudinal changes in bacterial susceptibility to a panel of antimicrobial agents, including tigecycline. In this study, we examine susceptibility among Gram-positive isolates collected from pediatric patients globally between 2004 and 2011. A total of 9,422 Gram-positive isolates were contributed by 1,255 centers, predominantly from Europe and North America. One-third of Staphylococcus aureus isolates were methicillin resistant, peaking in prevalence in 2007. All S. aureus isolates (n = 3,614) were susceptible to linezolid, tigecycline, and vancomycin; minocycline, imipenem, and meropenem were also highly active (>92% susceptibility). Ampicillin and penicillin susceptibility increased significantly during the study period (P < 0.0001 for both). Streptococcus pneumoniae isolates (n = 3,373) were highly susceptible to vancomycin (100%), linezolid (>99%), and levofloxacin and tigecycline (both >96%); imipenem susceptibility was low (32%) in Africa while minocycline susceptibility was low in Asia-Pacific Rim (38%). Penicillin resistance occurred in one-fifth of all S. pneumoniae isolates, with penicillin susceptibility ranging from 14% in Africa to 65% in Europe. Streptococcus agalactiae isolates (n = 1,056) were highly susceptible to most antimicrobials, although only 16% were susceptible to minocycline. Enterococcus faecalis isolates (n = 1,112) were highly susceptible (>97%) to ampicillin, linezolid, penicillin, tigecycline, and vancomycin globally, but only 34% were minocycline susceptible; minocycline susceptibility decreased significantly from 2004 to 2011 (P < 0.001). Tigecycline and linezolid were highly active against Enterococcus faecium (n = 267) globally (100% and 98% susceptible, respectively). Tigecycline and linezolid were highly active against Gram-positive pathogens from pediatric patients in TEST 2004 to 2011, with vancomycin and the carbapenems performing well against most pathogens.
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Logan LK. Carbapenem-resistant enterobacteriaceae: an emerging problem in children. Clin Infect Dis 2012; 55:852-9. [PMID: 22700827 DOI: 10.1093/cid/cis543] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Antibiotic resistance among gram-negative bacteria has reached critical levels. The rise of carbapenem resistance in Enterobacteriaceae carrying additional resistance genes to multiple antibiotic classes has created a generation of organisms nearly resistant to all available therapy. Carbapenem-resistant Enterobacteriaceae (CRE) infections are known to be associated with significant morbidity and mortality, and these pathogens have now made their way to the most vulnerable populations, including children. This review provides a brief overview of CRE, with a focus on CRE infections in children, and highlights available data on the epidemiology, clinical characteristics, carbapenemase types, risk factors, treatment, and outcomes of these multi-drug resistant infections in the pediatric population.
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Affiliation(s)
- Latania K Logan
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, Illinois, USA.
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Russett F. Recent Publications on Medications and Pharmacy. Hosp Pharm 2012. [DOI: 10.1310/hpj4704-317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.
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Affiliation(s)
- Flint Russett
- Department of Pharmacy, St. Francis Health Center, Topeka, Kansas
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