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Comparison of Carbapenem vs. Amikacin Antimicrobial Therapy for Pediatric Acute Pyelonephritis Caused by
Burcu Ceylan Cura Yayla1, Tuğba Bedir Demirdağ2, Anıl Tapısız2
1Department of Pediatric Infectious Diseases, Ankara Training and Research Hospital, University of Health Sciences, 06230 Ankara, Türkiye.
Insights
Amikacin is a viable alternative to carbapenems for treating pediatric acute pyelonephritis (APN) caused by extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae. Clinical outcomes were similar between amikacin and carbapenem groups, suggesting amikacin can be used when susceptibility is confirmed.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Bacteriology
Background:
- Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae present a significant challenge in pediatric acute pyelonephritis (APN).
- Carbapenems are often the primary treatment, raising concerns about resistance development.
- Alternative agents like amikacin may be underutilized despite demonstrated in vitro susceptibility.
Purpose of the Study:
- To compare the clinical efficacy of amikacin versus carbapenems for treating pediatric APN caused by ESBL-positive Enterobacteriaceae.
- To evaluate microbiological cure, clinical improvement, and recurrence rates between treatment groups.
Main Methods:
- Retrospective analysis of pediatric APN cases caused by ESBL-positive Enterobacteriaceae over two years.
- Comparison of treatment outcomes between patients receiving carbapenems and those receiving amikacin.
- Assessment of microbiological cure, clinical improvement, and recurrence rates.
Main Results:
- Fifty-five pediatric patients were analyzed; 35 received amikacin and 20 received carbapenems.
- The primary pathogens were E. coli and Klebsiella spp., all susceptible to both antibiotic classes in vitro.
- No significant differences were observed in microbiological cure, clinical improvement, or recurrence rates between the amikacin and carbapenem groups.
Conclusions:
- Amikacin demonstrates comparable clinical efficacy to carbapenems in treating pediatric ESBL-positive APN.
- Amikacin represents a potential alternative treatment option when in vitro susceptibility is confirmed.
- This finding supports antimicrobial stewardship by potentially reducing carbapenem reliance.
Abstract:
Objectives: Acute pyelonephritis (APN) caused by extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae poses a growing therapeutic challenge in children, as carbapenems remain the mainstay of treatment even when susceptibility to alternative agents such as amikacin is demonstrated. However, the widespread and inappropriate use of carbapenems can lead to carbapenem resistance. The aim of this study was to compare the clinical efficacy of amikacin and carbapenems in the management of pediatric acute pyelonephritis caused by ESBL-positive Enterobacteriaceae. Methods: We analyzed cases of pediatric acute pyelonephritis caused by ESBL-positive Enterobacteriaceae that were treated with either carbapenems or amikacin over a two-year period. This study compared microbiological cure, clinical improvement, and recurrence rates across the amikacin and carbapenem treatment groups. Results: Fifty-five patients were evaluated. The median age of the patients was 3 years (range, 0.1-13 years). The causative agents were E. coli in 43 cases (78.2%) and Klebsiella spp. in 12 cases (21.8%). All were susceptible to both carbapenem and amikacin in vitro. Twenty patients (36.3%) received a carbapenem and thirty-five (63.7%) received amikacin. Twenty-four (43.6%) had an underlying urological disease. No difference was observed between the groups in terms of microbiological cure, clinical improvement, or recurrence rates. Conclusions: Amikacin may be a potential alternative to carbapenems for treating pediatric ESBL-positive APN when in vitro susceptibility is confirmed.
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