Table 2.

Characteristics of adults previously reported with CNS infection treated with intraventricular TGS (2020–2022)

Patient No.	Study	Year	Age (yr)/sex	Country	Underlying disease (s)	Primary infection	Organism(s)	TGC MIC (mg/L)	TGC concentrations (mg/L)	Side effects	TGC, IV/CVI/IVT	LOT (days)	Co-administered antibiotics	Outcome	Time to CSF sterilization (day)
1	Lauretti et al. [2]	2017	22/M	Italy	A giant pituitary adenoma, post-resection CSF leak	Post-neurosurgical meningitis	XDRAB	2 μg/mL	NR	Chemical ventriculitis, myelitis (CST)	IV, 100 mg/q12 hr; IVT, 2 mg/(q24–12 hr)	IVT, 45; 1 month from the restart of the IVT IV, 14; IVT, 14	CST IVT, 120,000/q12 hr; MEP IV, 2 g/q8 hr; VAN IV, 1 g/q12 hr	Improved	75
2	Fang et al. [3]	2017	50/M	China	Craniocerebral injury	Post-neurosurgical meningitis	XDRAB	2 μg/mL	NR	None	IV, 100 mg/q12 hr; IVT, 3–4 mg/q12 hr	IV, 14; ITV, 14	CES IV, 3 g/q12 hr	Improved	14
3	Wang et al. [4]	2017	45/M	China		Post-lumbar puncture meningitis	MDRAB	NR (Kirby-Bauer antibiotic test, 17 mm)	1 mg/mL	None	IV, 50 mg q12 hr; IVT, 10 mg q12 hr	IV, 7 (discontinued before starting IVT TGC); IVT, 6	None	Improved	6
4	Long et al. [5]	2018	55/M	India	Intracerebellar hemorrhage, CSF leak, hydrocephalus, EVD	Post-neurosurgical ventriculitis	MDRAB	16 μg/mL	NR	None	IV, 100 mg q12; IVT, 4 mg/day	IV, 14; CVI, 14; IVT, 3	CES IV, 2 g/q8 hr	Improved	12
5	Tsolaki et al. [6]	2018	55/F	Greece	Aneurysmal subarachnoid hemorrhage	Post-neurosurgical VM	MDRAB	2 μg/mL	NR	None	IV, 100 mg q12 yr; IVT, 4 mg/day	IV TGC, 14; IVT TGC, 15; IVT CST, 22	IVT CST, 250 ×103 IU qd	Improved	4
6	Tsolaki et al. [6]	2018	50/M	Greece	Intraventricular mass resection, cerebral edema, EVD	Post-neurosurgical VM	MDRAB	1 μg/mL	NR	None	IV, NR; IVT	IV TGC, 15; IVT TGC, 15; IVT CST, 30	CST, 250 ×103 IU qd	Improved	5
7	Tsolaki et al. [6]	2018	48/M	Greece	Cerebellum spontaneous hemorrhage, EVD	Post-neurosurgical VM	MDRKP	NR	NR	None	IV, NR; IVT	IV TGC, 9; IVT TGC, 9; IVT CST, 11	CST, 125 ×103 IU qd	Improved	3
8	Liu et al. [7]	2018	70/F	China	Sub-arachnoid hemorrhage	Post-neurosurgical ventriculitis	XDRAB	≤1 μg/mL	NR	None	IV, 50 mg q12 hr; IVT, 2 mg q12 yr	IV TGC, 16; IVT TGC, 10	CES IV, 3 g/q8 hr	Improved	10
9	Wu et al. [8]	2018	67/M	China	Cerebral hemorrhage, EVD	Post-neurosurgical meningitis	MDRKP	NR	The trough concentrations of TGC in CSF for the three different dosages of TGC IV-ICV combined administration were 0.313, 1.290, and 2.886 mg/L for 40 mg IV/10 mg ICV, 45 mg IV/5 mg ICV, and 50 mg IV/1 mg ICV TGC, respectively	None	IV, 45 mg q12 hr, 40 mg q12 hr; IVT, 1 mg q12 hr, 5 mg q12 hr, 10 mg q12 hr	NR	TMP/SMX 480 mg q12 hr per os	Improved	42
10	Curebal et al. [9]	2018	28 days/M	Turkey	Congenital hydrocephalus, VPS placement	VPS infection	MDRAB	1 μg/mL	NR	None	IV, 1.2 mg/kg/day; IVT, 4 mg/day	IV TGC, 24; IVT TGC, 14	MEP IV, 120 mg/kg/day for 34 days	Died after the 1st month of discharge, because of pneumonia and sepsis. Blood culture was positive for XDRAB sensitive for colistin. TGC MIC value was 16 μg/mL	7
							After three negative CSF the patient was discharged						IVT AMK, 30 mg/ day for 10 days discontinued before starting IVT TGC
11	Pratheep et al. [10]	2019	Baby born at 27 wk gestation	India	Baby was born to a mother with prelabor premature rupture of membranes. At birth, baby had respiratory distress	Ventriculitis	XDRAB	NR	NR	None	IVT, 3 mg/day	IVT TGC, 2 wk	IVT CST, 5 mg/day for 4 wk	Improved	14
12	Deng et al. [11]	2019	17/M	China	Tuberculous meningitis	Post-neurosurgery intracranial infection	XDRAB	1 μg/mL	NR	None	IV,47.5 mg q12 hr; IVT, 4 mg q12 hr (after 4 days the clinical pharmacist advised changing from IVT to TGC ITC infusions; 4 mg daily)	IV TGC, 39; IVT TGC, 39	IV FOS, 4 g q8 hr; IV CES, 3 g q8 hr; after 4 days changed to IV MEP 2 g every q8 hr	Improved	39
13	Soto-Hernández et al. [12]	2019	38/M	México	Recent review of VPS. Hydrocephalus after cryptococcal meningitis in HIV+	Post-neurosurgical ventriculitis	MDRKO	<2 μg/mL	Peak concentrations achieved at 2 hr after the dose of between 178 and 310 μg/mL	None	IVT, 5 mg q24 hr	IVT TGC, 11	MEP, 6 g qd; AMK 15 mg/kg/day	Improved	3
14	Zhong et al. [13]	2020	33/M	China	Severe craniocerebral trauma	Post-neurosurgical intracranial infection	XDRAB	2 μg/mL	NR	Hepatic toxicity, no neurotoxic side effects	IV, 100 mg/q12 hr; IVT, 5 mg/q12 hr	IV TGC, 100 mg q12 hr for 7; IVT TGC, 5 mg q12 hr for 7	Sequential use of POLB IV, 100 mg q12 hr IV, POLB IVT, 10 mg qd, changed to qod × 2 wk IVT 4 days later	Improved	7 (after starting IV/IVT POLB)
											During the 7 days of the use IV/IVT TGC, CSF cellular and biochemical CSF markers improved; however, XDRAB was still present.
15	Abdallah et al. [14]	2020	53/M	Saudi Arabia	Cerebral hemorrhage in DM and uncontrolled hypertension	Post-neurosurgical meningitis and ventriculitis	MDRAB	4 μg/mL (intermediate susceptibility)	NR	After 8 hr of administering the first dose of IVT TGC, the patient developed myoclonic seizures for 4 min	IVT, TGC 2 mg q12 hr	IV TGC, 22; IVT TGC, 14; IV MEP, 24; IV TMP-SMX, 19	High-dose tigecycline (200-mg IV stat dose followed by 100-mg IV q12 hr), TMP/SMX (1,920-mg IV q6 hr)	Improved	14 (after starting IVT TGC)
16	Li et al. [15]	2021	68/M	China	Decompressive craniectomy and evacuation of traumatic cerebellar hematoma	Post-neurosurgical ventriculitis	MDRAB	NR	NR	None	IV, 50 mg q12 hr +; CVI, 4 mg q24 hr (in 50 mL of NS, at a rate of 12.5 mL/hr at a frequency of q6 hr)	IV TGC + CVI, 3; IV TGC + IVT, 7		Improved	10 (after starting IV + CVI),
											After 3 days: IV, 50 mg q12 day + IVT, 2 mg in 4 mL of NS in 2 min at a frequency of q8 hr				7 (after starting IV + IVT)
17	Huang et al. [16]	2022	16/F	China	Craniotomy for resection of vestibular schwannomas	Post-neurosurgery meningitis	XDRAB	2 μg/mL	NR	None	IV, 50 mg q12 hr; IVT, 5 mg q24 days	IV TGC + IVT TGC, 4 wk	IV CES, 3 g q8 days for 4 wk	Improved	4 wk
18	Huang et al. [16]	2022	80/M	China	Craniotomy for removal of frontal meningiomas	Post-neurosurgical ventriculitis	XDRAB	2 μg/mL	NR	None	IV, 50 mg q12 hr; IVT, 5 mg q24 days	IV TGC + IVT TGC, 10	IV CES, 3 g q8 days for 10 days	Improved	10
19	Li et al. [17]	2022	57/M	China	Hematoma removal after craniocerebral injury	Post-neurosurgical ventriculitis	CRKP	2 μg/mL	NR	None	IV, 100 mg qd; IVT, 3 mg q12 hr	14	IVT AMK, 0.8 g IV + 30 mg IVT qd	Improved	14
20	Wang et al. [18]	2022	53/M	China	Suboccipital decompression for an acute cerebellar infarction	Post-neurosurgical ventriculitis	CRKP	0.5 μg/mL	NR	None	IVT, 5 mg q12 days	IVT TGC, 6 (after intracerebroventricular injection of POLIB)	IV CAZ/AVI, 2.5 g + MAP, 2 g q 8 dahs	Improved	6 (22nd day of hospitalization)
21	Li et al. [19]	2022	31/M	China	Ventricular drainage performed subarachnoid hemorrhage	Post-neurosurgical ventriculitis	XDRAB	≤2 μg/mL	NR	None	IV, 100 mg q12 hr combined with IVT 5 mg qd	IVT TGC + IVT TGC, 33	IV MEP, 2 g IV q8 hr; VAN, 1 g q12 hr; IVT POLB, 50,000 IU qd	Improved	33 (after IV + IVT TGC),
															29 (after IVT POLB)

CNS, central nervous system; TGC, tygecicline; MIC, minimum inhibitory concentration; IV, intravenous; CVI, continuous ventricular irrigation; IVT, intraventricular therapy; LOT, length of treatment; CSF, cerebrospinal fluid; M, male; F, female; XDRAB, extensive drug resistant Acinetobacter baumannii; NR, not reported; CST, chemical sterilization therapy; MEP, meropenem; VAN, vancomycin; CES, cefoperazone-sulbactam; MDRAB, multidrug-resistant Acinetobacter baumannii; EVD, external ventricular device; MDRKP, multidrug resistant Klebsiella pneumoniae; TMP/SMX, trimethoprim-sulfamethoxazole; VPS, ventriculo-peritoneal shunt; AMK, amikacyn; ITC, intrathecal; FOS, fosfomycin; POLB, polimixyn B; DM, diabetes mellitus; POLIB, polimyxin B; CAZ/AVI, ceftazidime/avibactam.