Tigecycline salvage therapy for critically ill children with multidrug-resistant/extensively drug-resistant infections after surgery

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 >= 3 days 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 7.3 kg (IQR, 5.1-12.5 kg). Patients received tigecycline for a median 17 days (IQR, 12-20 days). The median intensive care unit stay was 56 days (IQR, 38-61 days) and median hospital stay was 78 days (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. (c) 2018 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.