LAUSR

To the Editor, We read with great interest the article by Ye et al. [3] regarding tigecycline treatment for severe infection in children. In this cohort, only one patient with meningitis received tigecycline without clinical improvement. Management of extensively drug-resistant (XDR) Acinetobacter baumannii meningitis remains a therapeutic challenge in children due to the limited treatment options [1, 2]. Tigecycline, a glycylcycline with a broad spectrum of antibacterial activity, is not approved for children. But in the era of nosocomial infections due to multidrugresistant bacteria, it can be a considerable option in lifethreatening infections [1]. Here, we report two infants, who were diagnosed with ventriculoperitoneal shunt (VPS) meningitis due to XDR A. baumannii under colistin combination therapy. The addition of tigecycline to the treatment regimen of patients resulted in cure. Both A. baumannii isolates recovered from the cerebrospinal fluid (CSF) cultures of the patients showed susceptibility only to tigecycline (Table 1). Identification and antimicrobial susceptibility testing of A. baumannii were performed using the VITEK 2 automated system (bioMerieux, Marcy l’Etoile, France). Although tigecycline is not approved for central nervous system infections, it was the only available option for the treatment of our patients according to the antibiotic susceptibility results. CSF cultures became negative with normal clinical condition and laboratory values only after tigecycline was added to the treatment. Both of the patients had received antimicrobial treatment in different combinations before and during tigecycline treatment (Table 1). Additionally, the infected shunt was removed and an external ventricular drainage catheter was inserted in both patients. Clinical and laboratory features of the patients are summarized in Table 1. In conclusion, tigecycline could be used as a salvage therapy, in combination with other antimicrobial agents, for children with VPS shunt meningitis caused by XDR A. baumannii when other therapies are not suitable.