Intrathecal or Intraventricular Tigecycline Therapy for Central Nervous System Infection Associated with Carbapenem-Resistant Klebsiella pneumoniae

Figures & data

Table 1 CSF Test Results (Case 1)

	Before IT Tigecycline Treatment (D10)	Post-IT Tigecycline Treatment (D26)
WBC (×10^6/L)	200	3
Protein (mg/L)	671	187
Glucose (mmol/L)	2.26	3

Abbreviations: CSF, cerebrospinal fluid; WBC, white blood cell.

Table 2 Antibiotic Susceptibility Tests for Klebsiella pneumoniae in CSF of Case 1

Antibiotics	Method	MIC (μg/mL)	Susceptibility
Amikacin	MIC	≥32	R
Cefuroxime sodium	MIC	≥64	R
Cefoxitin	MIC	≥64	R
Ceftazidime	MIC	≥64	R
Cefepime	MIC	≥32	R
Cefoperazone/sulbactam	MIC	≥64	R
Imipenem	MIC	≥16	R
Levofloxacin	MIC	≥8	R
Meropenem	MIC	≥16	R
Piperacillin tazobactam	MIC	≥128	R
Ciprofloxacin	MIC	≥4	R
Compound sulfamethoxazole	MIC	≥320	R
Tigecycline	K-B	19mm^a	S

Note: ^aAntibacterial circle diameter.

Abbreviations: CSF, cerebrospinal fluid; MIC, minimum inhibitory concentration; K-B, Kirby–Bauer; S, susceptible; R, resistant.

Table 3 CSF Test Results (Case 2)

	Before IV Tigecycline Treatment (D17)	Post IV Tigecycline Treatment (D22)	Before IVT Tigecycline Treatment (D24)	Post-IVT Tigecycline Treatment (D32)	Post-IVT Tigecycline Treatment (D39)
WBC (×10^6/L)	470	460	416	240	10
Protein (mg/L)	1099	929	1641	409	344
Glucose (mmol/L)	1.7	1.6	1.5	2.3	2.7

Abbreviations: CSF, cerebrospinal fluid; WBC, white blood cell.

Table 4 Antibiotic Susceptibility Tests for Klebsiella pneumoniae in CSF of Case 2

Antibiotics	Method	MIC (μg/mL)	Susceptibility
Amikacin	MIC	≥32	R
Cefuroxime sodium	MIC	≥64	R
Cefoxitin	MIC	≥64	R
Ceftazidime	MIC	≥64	R
Cefepime	MIC	≥32	R
Cefoperazone/sulbactam	MIC	≥64	R
Imipenem	MIC	≥16	R
Levofloxacin	MIC	≥8	R
Meropenem	MIC	≥16	R
Piperacillin tazobactam	MIC	≥128	R
Ciprofloxacin	MIC	≥4	R
Compound sulfamethoxazole	MIC	≥320	R
Tigecycline	K-B	19mm^a	S

Note: ^aAntibacterial circle diameter.

Abbreviations: CSF, cerebrospinal fluid; MIC, minimum inhibitory concentration; K-B, Kirby–Bauer; S, susceptible; R, resistant.

Table 5 Administration of Tigecycline in the Literatures

Reference	Age/Sex	Diagnosis	Strain	IV/CVI/ IT/IVT Tigecycline	Days to CSF Sterilization	Toxicity	Infection Outcome	Survival
[6]	17/Male	Meningitis	Acinetobacter baumannii	IV,47.5mg q12h; IVT,4mg q12h; IT,4 mg q24h	40	None	Cured	Yes
[24]	67/Male	Meningitis	Klebsiella pneumonia	IV, 49 mg q12h IVT, 1 mg q12h IV, 45 mg q12h IVT, 5 mg q12 h IV, 40 mg q12h IVT, 10 mg q12h	78	None	Cured	Yes
[25]	Five- month/Female	Central nervous system infections	Daptomycin- resistant VRE faecium	IV,1.2 mg/kg q12h IVT, 4 mg q24h	20	None	Cured	Yes
[26]	NR	Central nervous system infection	Acinetobacter baumannii	IV,50 mg q12h (after a loading dose of 100 mg); IT,10 mg q12h	14	None	Cured	Yes
[27]	55/Male	Meningitis	Acinetobacter baumannii	IV,100 mg q12h CVI,10mg q12h IV,50 mg q12h IVT, 2 mg q12h	17	None	Cured	Yes
[28]	50/Male	Intracranial infection	Acinetobacter baumannii	IV, 100 mg q12h IVT, 3 mg q12h IVT, 4 mg q12h	12	None	Cured	Yes
[29]	22/ Male	Meningitis	Acinetobacter baumannii	IV, 100 mg q12h IVT, 2 mg q24h IVT, 2mg q12h	75	None	Cured	Yes
[30]	Neonate/Male	VP shunt infection	Klebsiella pneumonia	IV,1.2 mg/kg/d, q12h IVT, 4 mg/d	24	None	Cured	No (Died of a blood-stream infection)
[31]	33/Male	Intracranial infection	Acinetobacter baumannii	IV, 100 mg q12h IVT, 5 mg q12h	7	Hepatic damage (suspected)	Cured	Yes
[32]	56/Male	Ventriculitis	Acinetobacter baumannii	IV, 100 mg q12h IVT, 2 mg q12h IVT, 4mg q12h	22	None	Cured	Yes
[33]	68/Male	Pyogenic ventriculitis	Acinetobacter baumannii	IV, 50 mg q12h (after a loading dose of 100 mg) CVI, 1 mg q6h IVT, 2 mg q8h	19	None	Cured	Yes
[34]	70/Female		Acinetobacter baumannii	IV, 50 mg q12h (after a loading dose of 100 mg) IVT, 2mg /q12h	17	None	Cured	Yes
[35]	53/Male	Intracranial infection	Klebsiella pneumoniae	IVT, 5mg q12h	9	None	Cured	Yes
[36]	31/Male	Intracranial infection	Acinetobacter baumannii	IV, 100 mg q12h IT, 5 mg q24h	33	None	Cured	Yes
[37]	16/Female	Meningitis	Acinetobacter baumannii	IV, 50 mg q12h IT, 5mg q24h	51	None	Cured	Yes
[37]	80/Male	Intracranial infection	Acinetobacter baumannii	IV, 50 mg q12h IT, 5mg q24h	27	None	Cured	Yes

Abbreviations: NR, not reported; IV, intravenous; IT, intrathecal; IVT, intraventricular; CVI, continuous ventricular irrigation; VRE, vancomycin-resistant enterococcus; VP, ventriculoperitoneal.

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