Poor central nervous system penetration of tigecycline in a patient with sepsis and ventriculitis caused by multidrug-resistant Klebsiella pneumoniae

Julie L. Chen, Jose Orsini, Claude Killu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To report the use of tigecycline in a case of ventriculitis and concurrent bacteremia. Case Summary: A 57-year-old African American male with a ruptured brain aneurysm was admitted to the intensive care unit after surgical intervention and external ventricular drainage placement. His hospital course was complicated by myocardial infarction, ventilator-associated pneumonia, ventriculitis, and sepsis, with multidrug-resistant (MDR) Klebsiella pneumoniae isolated from multiple sites, including blood and cerebral spinal fluid (CSF). The patient was treated with high doses of intravenous tigecycline and gentamicin along with intrathecal gentamicin. This combination eradicated infections outside the central nervous system (CNS) within 48 hours, but it took approximately 8 days for the CSF culture to become negative. Timed serum and CSF fluid samples were collected to determine CSF penetration of tigecycline on day 12 of therapy. CSF concentrations obtained 30 minutes after the dose and at the end of the dosing interval remained below the detectable limit of 0.05 μg/mL. Discussion: Although CSF tigecycline concentrations may not represent actual CNS tissue concentrations at the site of infection, the low CSF concentrations observed in our case may be responsible for the slow CSF clearance of infection. It was not clear whether gentamicin therapy alone, administered both intravenously and intrathecally, would have achieved the same outcome and cleared the infection from the CNS in this patient. Conclusions: Until additional clinical data are available, tigecycline should not be used for the management of MDR infections associated with the CNS.

Original languageEnglish (US)
Pages (from-to)344-348
Number of pages5
JournalJournal of Pharmacy Technology
Volume23
Issue number6
StatePublished - Nov 2007

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Klebsiella pneumoniae
Sepsis
Central Nervous System
Gentamicins
Central Nervous System Infections
Infection
Ventilator-Associated Pneumonia
Nerve Tissue
Ruptured Aneurysm
Intracranial Aneurysm
Bacteremia
African Americans
Intensive Care Units
Drainage
Myocardial Infarction
tigecycline
Therapeutics
Serum

ASJC Scopus subject areas

  • Pharmaceutical Science

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Poor central nervous system penetration of tigecycline in a patient with sepsis and ventriculitis caused by multidrug-resistant Klebsiella pneumoniae. / Chen, Julie L.; Orsini, Jose; Killu, Claude.

In: Journal of Pharmacy Technology, Vol. 23, No. 6, 11.2007, p. 344-348.

Research output: Contribution to journalArticle

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abstract = "Objective: To report the use of tigecycline in a case of ventriculitis and concurrent bacteremia. Case Summary: A 57-year-old African American male with a ruptured brain aneurysm was admitted to the intensive care unit after surgical intervention and external ventricular drainage placement. His hospital course was complicated by myocardial infarction, ventilator-associated pneumonia, ventriculitis, and sepsis, with multidrug-resistant (MDR) Klebsiella pneumoniae isolated from multiple sites, including blood and cerebral spinal fluid (CSF). The patient was treated with high doses of intravenous tigecycline and gentamicin along with intrathecal gentamicin. This combination eradicated infections outside the central nervous system (CNS) within 48 hours, but it took approximately 8 days for the CSF culture to become negative. Timed serum and CSF fluid samples were collected to determine CSF penetration of tigecycline on day 12 of therapy. CSF concentrations obtained 30 minutes after the dose and at the end of the dosing interval remained below the detectable limit of 0.05 μg/mL. Discussion: Although CSF tigecycline concentrations may not represent actual CNS tissue concentrations at the site of infection, the low CSF concentrations observed in our case may be responsible for the slow CSF clearance of infection. It was not clear whether gentamicin therapy alone, administered both intravenously and intrathecally, would have achieved the same outcome and cleared the infection from the CNS in this patient. Conclusions: Until additional clinical data are available, tigecycline should not be used for the management of MDR infections associated with the CNS.",
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