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Treatment of Carbapenem-Resistant Enterobacteriaceae Infections in Children

Kathleen Chiotos1,2,3,4, Molly Hayes4, Jeffrey S Gerber1,3,4

  • 1Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Journal of the Pediatric Infectious Diseases Society
|December 25, 2019
PubMed

Insights

This review offers a framework for treating carbapenem-resistant Enterobacteriaceae (CRE) infections in children. It summarizes FDA-approved antibiotics and addresses challenges in pediatric CRE treatment.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Clinical Pharmacology

Background:

  • Carbapenem-resistant Enterobacteriaceae (CRE) infections pose a growing threat to children, often leading to severe outcomes.
  • Optimal treatment for pediatric CRE infections is complex due to limited pediatric data and drug approvals.

Purpose of the Study:

  • To provide a framework for managing CRE infections in pediatric patients.
  • To review FDA-approved antibiotics with CRE activity for use in children.
  • To highlight challenges in pediatric CRE treatment.

Main Methods:

  • Literature review of FDA-approved antibiotics with CRE activity as of September 2019.
  • Analysis of pediatric-specific data and dosing considerations for relevant agents.
  • Framework development for clinical decision-making in pediatric CRE infections.

Main Results:

  • Summary of available data for carbapenems, ceftazidime-avibactam, meropenem-vaborbactam, imipenem/cilastatin-relebactam, polymyxins, tigecycline, eravacycline, and plazomicin.
  • Identification of challenges including lack of pediatric comparative data and uncertain dosing.
  • Framework presented for guiding treatment decisions.

Conclusions:

  • Effective management of pediatric CRE infections requires careful consideration of available antibiotic options and specific challenges.
  • Further research and development of pediatric-indicated antibiotics are crucial.
  • The provided framework aids clinicians in navigating treatment choices for pediatric CRE infections.

Keywords:
Klebsiella pneumoniae carbapenemasegram-negative resistancemultidrug-resistant organismpediatrics

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