Outcomes of Empirical Antimicrobial Therapy for Pediatric Community-onset Febrile Urinary Tract Infection in the Era of Increasing Antimicrobial Resistance

Abstract

BackgroundUrinary tract infection (UTI) is a common cause of fever in children. Since infections caused by extended-spectrum β-lactamase (ESBL)-producing organism in the community have increased, alternative empirical antimicrobials to carbapenems have been studied. We conducted this study to compare clinical outcomes between group receiving empirical antimicrobials to which organisms were susceptible vs. non-susceptible in community-onset UTI.MethodsWe conducted a retrospective cohort study of pediatric patients with first-episode community-onset febrile UTI caused by Escherichia coli, Klebsiella pneumoniae and Proteus spp. at Ramathibodi Hospital from 2011 to 2017. Patients were classified into group receiving empirical antimicrobials to which organisms were susceptible and non-susceptible. Medical records were reviewed to assess clinical outcomes in both groups.ResultsOne hundred and fifty-one eligible patients were enrolled in this study. The most common causative organism was E. coli (89.6 and 96.2% in the group receiving susceptible and non-susceptible antimicrobials, respectively). Among causative organisms, 19.8% were ESBL-producing organisms. Ceftriaxone was used in 76.8% of our patients. There was no significant difference in clinical, microbiological, relapse, time to defervescence between two groups of patients. None of patients in both groups developed sepsis after receiving empirical therapy. However, length of stay was significantly longer in group receiving antimicrobials to which organisms were non-susceptible (5.12 ± 3.187 vs. 8.54 ± 5.186, P = 0.008).ConclusionThis study found no significant difference in the treatment outcomes between pediatric patients receiving antimicrobials to which organisms were susceptible and non-susceptible for the treatment of UTI.In the era of increasing antimicrobial resistance, third-generation cephalosporins are still a good choice as an empirical antimicrobial for children with community-onset UTI.Disclosures All authors: No reported disclosures.

Acute Focal Bacterial Nephritis Caused by Staphylococcus simulans

“…However, in terms of concerns regarding treatment failure and the perspective of antibiotic de-escalation, we adjusted the initially prescribed antibiotics to a set that targeted S. simulans infection for an additional 21 days. Switching to the appropriate antibiotics to which the etiological organisms are susceptible was recommended in a previous study [11]. Consequently, no bacterial recurrence was observed.…”

Renal abscess with bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli: a case report

“…Carbapenem treatment needs to be given intravenously and requires a longer duration of hospital stay [15,16]. Two previous retrospective studies showed that the initial empiric antibiotic therapy for pediatric UTIs caused by ESBL did not worsen the outcome, and the authors concluded that switching to appropriate antibiotics after detection of ESBL-producing microorganisms was sufficient [17,18]. The efficacy of non-carbapenem antibiotics such as amikacin, fosfomycin, cefmetazole, and flomoxef for UTIs with ESBL-producing bacteria has been reported [9,15,19].…”

Treatment of UTIs in Infants <2 Months: A Living Systematic Review

“…One study by Amodio et al 34 was not included in the meta-analysis because of clinical heterogeneity because it was conducted in 1978 with a different antimicrobial resistance profile, compared with the more recent studies. In their study, Kantamalee et al 36 included 21 patients <2 months of age. All patients received a short duration of parenteral antibiotics, and the study was not included in the primary meta-analysis (only included for the secondary comparison of short versus long duration of total antibiotics).…”

“…3 In this systematic review, we identified 6 observational studies that targeted this question. 12,[34][35][36][37]40 Similarly, no difference in recurrence was noted when comparing #10 to >10 days.…”