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Isolation and Identification of Waterborne Antibiotic-Resistant Bacteria and Molecular Characterization of their Antibiotic Resistance Genes
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Risk associated with a systematic search of extended-spectrum β-lactamase-producing Enterobacteriaceae

Roberta Prinapori1, Julie Guinaud, Antoine Khalil

  • 1Infectious Disease Department, Necker-Enfants-Malades Hospital, AP-HP, Université Paris-Descartes, Paris, France.

American Journal of Infection Control
|October 16, 2012
PubMed

Insights

Hospitalized children with previous ESBL colonization often received excessive carbapenem antibiotics. Most antibiotic courses required deescalation, highlighting the need for programs to reduce carbapenem use and combat resistance.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Pediatrics

Background:

  • Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae colonization is a growing concern in pediatric populations.
  • Hospitalized children with suspected infections often receive broad-spectrum antibiotics, including carbapenems.

Purpose of the Study:

  • To evaluate antibiotic prescribing patterns in hospitalized children with prior ESBL colonization.
  • To assess the appropriateness of carbapenem use and the feasibility of deescalation in this patient group.

Main Methods:

  • Retrospective evaluation of 74 hospitalized children with previous fecal ESBL colonization.
  • Analysis of antibiotic therapy, focusing on carbapenem use and subsequent deescalation rates.

Main Results:

  • 86.5% of patients received carbapenem agents, despite only 3 patients (4%) being infected with ESBL-producing Enterobacteriaceae.
  • 95% of initial antibiotic courses were deemed excessive and candidates for deescalation.
  • Successful deescalation was achieved in only 62% of appropriate cases.

Conclusions:

  • Carbapenem use is frequently excessive in hospitalized children with prior ESBL colonization.
  • Deescalation of antibiotic therapy is challenging, indicating a need for improved stewardship.
  • Implementing ESBL control programs can reduce carbapenem use and mitigate the rise of gram-negative bacilli resistance.

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