TIGECYCLINE in children showed favorable outcomes and acceptable tolerability in multidrug-resistant bacterial infections.
Tigecycline In Children with Resistant Infections
Pediatric data on tigecycline remain limited, particularly for multidrug-resistant infections caused by gram-negative bacteria. New single-center experience from a tertiary care setting offers clinically relevant insight into its use in critically ill children, many of whom required intensive care and combination antimicrobial therapy.
The retrospective cohort included 143 pediatric patients treated with tigecycline between January 2018 and September 2023. Dosing was reported as 1–1.2 mg/kg or 50 mg twice daily. Most patients were severely ill, with 72.0% requiring intensive care admission and 66.4% receiving combination therapy.
Klebsiella pneumoniae was the most common pathogen, identified in 72.0% of cases, followed by Acinetobacter baumannii in 17.5%. Carbapenem resistance was present in 87% of isolates, underscoring the complexity of treatment decisions in this pediatric population.
Clinical Success Reached 76.9%
Clinical success, defined as infection resolution with normalization of markers, was achieved in 76.9% of patients. The findings suggest that tigecycline in children may have a role in difficult to treat multidrug-resistant infections, although the clinical context remains important.
Intensive care admission and combination therapy independently predicted treatment failure. These findings likely reflect the severity and complexity of illness among patients requiring escalated support or multiple antimicrobials, rather than a direct negative effect of combination treatment.
Overall infection-related mortality was 28.7%. Intensive care admission was the only independent predictor of mortality, reinforcing the impact of baseline illness severity on outcomes in children with resistant gram-negative bacterial infections.
Tolerability Findings Support Further Study
Paired laboratory values showed no significant hepatic, pancreatic, or hematologic changes during tigecycline use. One biliary sludge event was recorded. Together, the findings suggest acceptable tolerability in this cohort, including among critically ill children.
The study adds to limited pediatric evidence on tigecycline, a glycylcycline antimicrobial, but important limitations remain. Its single-center retrospective design, lack of a control group, and frequent concomitant antibiotic use limit generalizability. Prospective trials are needed to clarify optimal use, patient selection, and comparative outcomes for tigecycline in children with multidrug-resistant infections.
Reference
Gençeli M et al. Tigecycline use in children with multidrug-resistant infections: a single-center experience. Expert Rev Anti Infect Ther. 2026; doi:10.1080/14787210.2026.2670678.
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