Cephalosporins for first febrile urinary tract infection from Enterobacteriaceae with antimicrobial resistance in young children

Clinical Outcomes of Children With Extended-spectrum ß -Lactamase Urinary Tract Infection Receiving Discordant Empiric Antibiotic: A Comparative Study of Fever Duration, Length of Stay, and Readmissions

“…16 A 2021 retrospective study investigating the short-term response to third-generation cephalosporins in children presenting with cephalosporin-resistant bacterial UTIs indicated that treatment was successful based on clinical response, defined as fever resolution and microbiological response (sterile repeat urine culture). 10 A plausible explanation of why third-generation cephalosporin treatment leads to clinical improvement in ESBL is achievement of sufficient pharmacodynamic levels by a third-generation cephalosporin, specifically time above the minimum inhibitory concentration (MIC) in the urinary tract. Antibiotics are primarily renally excreted, this makes it possible that urine concentrations reach up to 100 to 1000 times higher than serum levels and thus allow antibiotics to achieve an adequately high concentration.…”

“…16 A 2021 retrospective study investigating the short-term response to third-generation cephalosporins in children presenting with cephalosporin-resistant bacterial UTIs indicated that treatment was successful based on clinical response, defined as fever resolution and microbiological response (sterile repeat urine culture). 10…”

“…17 This is supported by data collected in a study showing high concentrations of cefuroxime in the urine compared with the plasma of patients treated with intravenous cefuroxime. 10 In a murine model of ESBL positive and ESBL negative mice, bacterial burden was eliminated on day 6 of ceftriaxone administration. However, there were more renal alterations in the ESBL positive group.…”

“…Several studies outside the United States have demonstrated clinical improvement in such cases despite discordant antibiotic use (laboratory confirmation of bacterial resistance to the empiric treatment choice). 10,11 In this single-center retrospective study, we aim to evaluate the clinical outcomes of ESBL UTIs compared with non-ESBL UTIs in children.…”

“…Several studies outside the United States have demonstrated clinical improvement in such cases despite discordant antibiotic use (laboratory confirmation of bacterial resistance to the empiric treatment choice). 10,11…”