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Assessment of Intestinal Transcytosis of Neonatal Escherichia coli Bacteremia Isolates
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Clinical implications of inducible beta-lactamase activity in Gram-negative bacteremia in children

Robert J Boyle1, Nigel Curtis, Nigel Kelly

  • 1Department of Paediatrics, Murdoch Children's Research Institute, Melbourne University, Melbourne, Victoria, Australia. BobBoyle@doctors.org.uk.

The Pediatric Infectious Disease Journal
|October 24, 2002
PubMed
Abstract

Insights

Beta-lactam resistance emergence during Extended Spectrum Cephalosporin producing Gram-negative Pathogens (ESCaPPM) sepsis in children is uncommon but can lead to adverse outcomes. Combination therapy with extended spectrum penicillin and aminoglycoside may be preferred over carbapenems or quinolones.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Hospital-Acquired Infections

Background:

  • Extended Spectrum Cephalosporin producing Gram-negative Pathogens (ESCaPPM) are significant causes of hospital-acquired bacteremia and meningitis in children.
  • These organisms possess the potential for developing beta-lactam resistance during antimicrobial therapy, a phenomenon with potentially adverse clinical consequences.
  • The frequency of beta-lactam resistance development and optimal treatment strategies for ESCaPPM infections in pediatric populations remain understudied.

Purpose of the Study:

  • To determine the incidence of beta-lactam resistance emergence during the treatment of ESCaPPM sepsis in children.
  • To evaluate the optimal therapeutic regimens for pediatric ESCaPPM sepsis, comparing combination antimicrobial therapy and carbapenems.

Main Methods:

  • A retrospective review of case notes and microbiological records was conducted.
  • The study encompassed all cases of ESCaPPM bacteremia and meningitis managed at a tertiary children's hospital over a six-year period.

Main Results:

  • Fifty-eight cases of ESCaPPM sepsis were identified. Beta-lactam resistance emerged in 5% (3 cases) of these patients, leading to adverse clinical outcomes in two instances.
  • Treatment outcomes were comparable between patients receiving carbapenems and those treated with a combination of beta-lactam and aminoglycoside.
  • Prior antimicrobial exposure influenced resistance patterns, with higher rates of cefotaxime resistance observed in children with recent carbapenem, cephalosporin, or penicillin use.

Conclusions:

  • The emergence of beta-lactam resistance during ESCaPPM sepsis treatment is infrequent in this pediatric cohort but carries significant clinical risks.
  • For susceptible isolates, an extended spectrum penicillin combined with an aminoglycoside may be a preferred first-line treatment for ESCaPPM sepsis compared to carbapenems or quinolones.

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