Outcome of Antimicrobial Therapy of Pediatric Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae
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Background: The purpose of this study was to compare the outcome of carbapenem versus non-carbapenem antimicrobial therapyfor pediatric urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae. Materials and Methods: From 2006 to 2011, 42 episodes of UTI caused by ESBL-producing Enterobacteriaceae were diagnosed atSeoul National University Children’s Hospital. Patients were grouped according to the antimicrobials they received into a carbapenemgroup and a non-carbapenem group. Medical records were retrospectively reviewed to assess treatment outcome, time to defervescenceafter initiation of treatment, and relapse rate. Results: There 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 Klebsiellapneumoniae . 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 timeof antimicrobial discontinuation. Between the carbapenem and the non-carbapenem treatment groups, there were no significant differencesin 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 antimicrobialtreatment, and the relapse rate in the non-carbapenem group. Conclusions: This study found no significant difference in the treatment outcome between pediatric patients treated with carbapenemand 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.
Abstract
Background: The purpose of this study was to compare the outcome of carbapenem versus non-carbapenem antimicrobial therapyfor pediatric urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae. Materials and Methods: From 2006 to 2011, 42 episodes of UTI caused by ESBL-producing Enterobacteriaceae were diagnosed atSeoul National University Children’s Hospital. Patients were grouped according to the antimicrobials they received into a carbapenemgroup and a non-carbapenem group. Medical records were retrospectively reviewed to assess treatment outcome, time to defervescenceafter initiation of treatment, and relapse rate. Results: There 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 Klebsiellapneumoniae . 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 timeof antimicrobial discontinuation. Between the carbapenem and the non-carbapenem treatment groups, there were no significant differencesin 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 antimicrobialtreatment, and the relapse rate in the non-carbapenem group. Conclusions: This study found no significant difference in the treatment outcome between pediatric patients treated with carbapenemand 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.
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