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Outcome of Antimicrobial Therapy of Pediatric Urinary Tract Infections Caused by Extended-Spectrum
Bongjin Lee1, Soo Young Kang1, Hyun Mi Kang1
1Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
Insights
For pediatric urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae, carbapenem and non-carbapenem therapies showed similar outcomes. This suggests non-carbapenem antibiotics can be continued if patients show clinical improvement.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Microbiology
Background:
- Pediatric urinary tract infections (UTIs) can be caused by extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae.
- Treatment of these infections requires careful consideration of antimicrobial agents.
Purpose of the Study:
- To compare the effectiveness of carbapenem versus non-carbapenem antimicrobial therapy for pediatric UTIs caused by ESBL-producing Enterobacteriaceae.
- To evaluate treatment outcomes, time to defervescence, and relapse rates.
Main Methods:
- Retrospective review of 42 UTI episodes in children from 2006-2011.
- Patients were categorized into carbapenem and non-carbapenem treatment groups.
- Outcomes assessed included treatment success, time to fever resolution, and infection recurrence.
Main Results:
- No significant differences were observed between carbapenem and non-carbapenem groups regarding bacterial etiology, time to defervescence, or relapse rates.
- In vitro susceptibility to non-carbapenem agents did not impact treatment outcomes.
- Treatment failure was not observed at the discontinuation of antimicrobials.
Conclusions:
- Carbapenem and non-carbapenem therapies demonstrate comparable outcomes for pediatric UTIs caused by ESBL-producing Enterobacteriaceae.
- Non-carbapenem antimicrobial therapy can be safely continued in pediatric UTI patients who show clinical improvement.
Background:
The purpose of this study was to compare the outcome of carbapenem versus non-carbapenem antimicrobial therapy for 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 at Seoul National University Children's Hospital. Patients were grouped according to the antimicrobials they received into a carbapenem group and a non-carbapenem group. Medical records were retrospectively reviewed to assess treatment outcome, time to defervescence after 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 Klebsiella pneumoniae. 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 time of antimicrobial discontinuation. Between the carbapenem and the non-carbapenem treatment groups, there were no significant differences in 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 antimicrobial treatment, 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 carbapenem and 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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