Outcome of Antimicrobial Therapy of Pediatric Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae

Abstract

BackgroundThe purpose of this study was to compare the outcome of carbapenem versus non-carbapenem antimicrobial therapy for pediatric urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae.Materials and MethodsFrom 2006 to 2011, 42 episodes of UTI caused by ESBL-producing Enterobacteriaceae were diagnosed at Seoul National University Children's Hospital. Patients were grouped according to the antimicrobials they received into a carbapenem group and a non-carbapenem group. Medical records were retrospectively reviewed to assess treatment outcome, time to defervescence after initiation of treatment, and relapse rate.ResultsThere were 36 children with 42 episodes of UTI caused by ESBL-producing Enterobacteriaceae. Twenty-seven cases (64%) had an underlying urologic disease, 28 (67%) cases were caused by Escherichia coli, and 14 (33%) cases were caused by Klebsiella pneumoniae. Four (10%) cases were treated with carbapenem, 23 cases (55%) were treated with non-carbapenem, and 15 (36%) cases were treated by switching from a carbapenem to a non-carbapenem and vice versa. There was no treatment failure at the time of antimicrobial discontinuation. Between the carbapenem and the non-carbapenem treatment groups, there were no significant differences in bacterial etiology (P = 0.59), time to defervescence after the initiation of antimicrobials (P = 0.28), and relapse rate (P = 0.50). In vitro susceptibility to non-carbapenem antimicrobials did not affect the time to defervescence after the initiation of antimicrobial treatment, and the relapse rate in the non-carbapenem group.ConclusionsThis study found no significant difference in the treatment outcome between pediatric patients treated with carbapenem and those treated with non-carbapenem antimicrobials for UTI caused by ESBL-producing Enterobacteriaceae. Therefore, the initially administered non-carbapenem can be maintained in UTI patients showing clinical improvement.

Extended‐spectrum β‐lactamase‐producing bacteria caused less than 5% of urinary tract infections in a paediatric emergency centre

“…As expected, we observed a high rate of E coli in samples of ESBL-producing bacteria (19), but more importantly, the rate of infection with Klebsiella was higher in the ESBL group than in the non-ESBL group. Travel abroad during the previous six months, by the patient or their family, was not a significant risk factor in our case study, whereas this was identified as a risk factor in other studies (8,20). Travel abroad during the previous six months, by the patient or their family, was not a significant risk factor in our case study, whereas this was identified as a risk factor in other studies (8,20).…”

High rates of multidrug resistance among uropathogenic Escherichia coli in children and analyses of ESBL producers from Nepal

“…ESBL producing bacteria causing infections in children may have various complications and adverse outcomes [30]. ESBL producers are non susceptible to aminopenicillins and ureidopenicillins as well as extended-spectrum β-lactam agents like second- and third-generation cephalosporins.…”

Gambaran Terapi dan Luaran Infeksi Saluran Kemih oleh Bakteri Penghasil Extended Spectrum Beta Lactamase pada Anak di RSUD Dr. Soetomo Surabaya

“…Keduanya menghasilkan angka treatment success rate yang sama-sama 100%. 15 Tidak ada pedoman khusus pada terapi pasien ISK oleh bakteri penghasil ESBL. Studi terkait perbandingan penggunaan terapi, terutama pada pasien anak masih sedikit.…”

“…Meskipun nonkarbapenem diberikan untuk strain resisten, konsentrasi yang relatif tinggi dapat menyebabkan keberhasilan pengobatan walaupun bertentangan dengan hasil uji kepekaan antimikroba. 15 Penggunaan antibiotik nonkarbapenem sebelum pasien kemudian beralih terapi karbapenem digolongkan dalam kelompok terapi karbapenem. Hal tersebut tidak bisa disimpulkan bahwa pemakaian karbapenem sesuai hasil uji sensitivitas tidak dipengaruhi antibiotik lain sebelumnya.…”