Background: Increasing prevalence of multidrug-resistant Gram-negative bacteria (MDR-GNB) necessitates the use of tigecycline in children, yet pediatric-specific data are limited. Objectives: To evaluate the clinical and microbiologic outcomes, susceptibility patterns and safety profile of tigecycline in pediatric MDR-GNB infections. Methods: A retrospective observational study was conducted at a tertiary university hospital from January 2015 to December 2024. We included patients aged ≤18 years who received tigecycline for ≥48 hours for confirmed MDR-GNB infections. Results: Forty-six treatment episodes were identified in 43 patients (median age: 16 months; interquartile range, 2–100). The majority (91.3%) required intensive care, with ventilator-associated pneumonia (56.5%) being the primary indication. Causative pathogens were carbapenem-resistant Acinetobacter baumannii (69.6%), carbapenem-resistant Enterobacterales (23.9%) and Stenotrophomonas maltophilia (6.5%). Clinical improvement was achieved in 73.9% of episodes, and microbiologic eradication in 60.9%. Although 45.7% of isolates were nonsusceptible to tigecycline (minimum inhibitory concentration >2 mg/L), clinical success remained high. Higher improvement rates were observed in children aged ≥8 years and those receiving a loading dose, though statistical significance was not reached. Adverse events were mild and predominantly gastrointestinal; no treatment discontinuations due to toxicity were reported. Conclusions: Tigecycline is a viable salvage therapy for severe pediatric MDR-GNB infections, demonstrating a manageable safety profile. However, the mortality rate of 23.9% and relatively modest microbiologic eradication rates underscore the complexity of such infections and emphasize the pressing need for pharmacokinetic data to refine dosing in younger children, where evidence remains sparse.
Suphap et al. (2026) studied this question.