Outcome of Urinary Tract Infections Caused by Extended Spectrum β-Lactamase-producing Enterobacteriaceae in Children

Tratselas, Athanasios; Iosifidis, Εlias; Ioannidou, Maria; Saoulidis, Stamatis; Kollios, Konstantinos; Antachopoulos, Charalampos; Sofianou, Danai; Roilides, Emmanuel

doi:10.1097/inf.0b013e31820d7ec4

Cited by 55 publications

(45 citation statements)

References 9 publications

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“…However, patients commonly improve despite reported resistance to the antibiotic that was started (37). Possible explanations are that the child had contaminated urine rather than a true UTI, the child has asymptomatic bacteruria or the bacteria were susceptible in-vivo despite in-vitro resistance.…”

Section: Management Of Positive Urine Cultures With Multi-resistant Bmentioning

confidence: 86%

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Robinson

Saux

2016

Expert Review of Anti-infective Therapy

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The article reviews indications for and interpretation of urinalysis and urine culture results for diagnosis of UTI, choice of antibiotics for empiric and definitive UTI therapy, the rationale behind and indications for radiographic investigations, and prevention of UTIs including the complex decision as to whether antibiotic prophylaxis will benefit a child. Expert commentary: Over-diagnosis of UTI is a prevalent problem due to the lack of specificity of both urinalysis and urine culture. The most major recent advance in the field has been the recognition that antibiotic prophylaxis for UTI is rarely indicated as in most situations, the number needed to treat to prevent one UTI is too high to justify the risk of adverse events and development of antimicrobial resistance.

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Section: Management Of Positive Urine Cultures With Multi-resistant Bmentioning

confidence: 86%

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Robinson

Saux

2016

Expert Review of Anti-infective Therapy

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“…In a previous study, we have shown that hospitalized children with UTI caused by ESBL-producing bacteria had favorable clinical and microbiological outcomes despite inappropriate empirical therapy compared to children with UTI caused by non-ESBLproducing bacteria who were receiving appropriate therapy (27). Furthermore, two of the children with UTI caused by ESBL-producing bacteria showed clinical and microbiological responses on the 1st day of the inappropriate therapy administration (27).…”

Section: Discussionmentioning

confidence: 95%

Effect of Ceftriaxone on the Outcome of Murine Pyelonephritis Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coli

Tratselas

Simitsopoulou

Giannakopoulou

et al. 2014

Antimicrob Agents Chemother

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dUrinary tract infections (UTIs) due to extended-spectrum-␤-lactamase (ESBL)-producing Enterobacteriaceae in children are becoming more frequent, and they are commonly treated initially with a second-or third-generation cephalosporin. We developed a murine model of ascending UTI caused by ESBL-producing Escherichia coli. Using this model, we investigated the renal bacterial burden, interleukin-6 (IL-6) expression, and histopathological alterations caused by ESBL-and non-ESBL-producing bacteria after 1, 2, or 6 days with or without ceftriaxone therapy. The renal bacterial burden, IL-6 concentration, and histological inflammatory lesions were not significantly different between mice infected with ESBL-and non-ESBL-producing bacteria without treatment at any of the time points examined. Following ceftriaxone administration, the bacterial burden was eliminated in the kidneys of mice infected with ESBL-and non-ESBL-producing bacteria on the 6th postinfection day. The histological analysis demonstrated that among mice treated with ceftriaxone, those infected with ESBL-producing bacteria had more profound renal alterations than those infected with non-ESBL-producing bacteria on the 6th day (P < 0.001). In comparison, microbiological outcomes did not differ significantly between mice infected with ESBL-and non-ESBL-producing bacteria at any of the time points examined. The effectiveness of ceftriaxone in mice with UTIs due to ESBL-producing E. coli may have therapeutic implications; it is, however, hampered by limited activity on the histopathological lesions, a finding that needs further investigation. E xtended-spectrum ␤-lactamases (ESBL) are enzymes that hydrolyze penicillins, cephalosporins of the first, second, and third generations, and aztreonam and are mostly produced by Enterobacteriaceae (1, 2). Since their discovery, ESBL enzymes have spread in many microorganisms and have caused a wide variety of infections in all age groups worldwide (3, 4). Infections caused by ESBL-producing bacteria are difficult to treat, as these bacteria are generally resistant to the empirical therapy commonly used (5-13). Infections caused by such bacteria are believed to have worse outcomes than infections caused by non-ESBL-producing bacteria (5, 6, 9). It is not clear whether the worse outcomes of infections caused by ESBL-producing bacteria are attributable to the greater pathogenicity of the invading bacteria, to inappropriate initial therapy, or to both.Urinary tract infections (UTIs) are common causes of morbidity in children and adults (14-16). UTIs caused by ESBL-producing bacteria have been spreading in both nosocomial settings and in the community (17-19). It is unclear whether UTIs caused by ESBL-producing bacteria share the unfavorable outcomes of other ESBL infections, such as sepsis or pneumonia. We developed an ascending UTI model in BALB/c mice in order to study the microbiological, inflammatory, and immunological aspects of UTIs caused by ESBL-producing bacteria and the effect of ceftriaxone, a third-generation ce...

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“…They found that patients with resistant isolates had worse outcomes as defined by longer symptom duration, higher rates of reconsultation, more subsequent antibiotic usage, and higher rates of significant bacteriuria at 1 month. Although one would expect that a UTI due to an extended-spectrum ␤-lactamase (ESBL)-producing Enterobacteriaceae would result in treatment failure using noncarbapenem ␤-lactam agents, this was refuted in several studies (44)(45)(46) in which children with UTIs due to ESBL-producing strains all had favorable clinical and microbiological outcomes despite being treated with ␤-lactam agents that were categorized as resistant by in vitro AST.…”

Section: Susceptibility Testing In Pediatric Urinary Tract Infectionmentioning

confidence: 99%

Diagnosis of Urinary Tract Infections in Children

Doern

Richardson

2016

J Clin Microbiol

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bUrinary tract infections (UTIs) are a common occurrence in children. The management and laboratory diagnosis of these infections pose unique challenges that are not encountered in adults. Important factors, such as specimen collection, urinalysis interpretation, culture thresholds, and antimicrobial susceptibility testing, require special consideration in children and will be discussed in detail in the following review.

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Outcome of Urinary Tract Infections Caused by Extended Spectrum β-Lactamase-producing Enterobacteriaceae in Children

Cited by 55 publications

References 9 publications

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Effect of Ceftriaxone on the Outcome of Murine Pyelonephritis Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coli

Diagnosis of Urinary Tract Infections in Children

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