Clinical implications of inducible beta-lactamase activity in Gram-negative bacteremia in children.
BACKGROUND
Organisms of the spp., indole-positive spp., spp. and (ESCaPPM) group are a common cause of hospital-acquired bacteremia and share the potential to develop beta-lactam resistance during therapy. The emergence of such resistance may have adverse consequences, but the frequency with which this occurs has not been studied in children. It has been suggested that such organisms should be treated with combination antimicrobials or carbapenems, but the optimal regimen is uncertain. AIM To determine the frequency with which beta-lactam resistance develops during ESCaPPM sepsis in children and the optimal treatment of such sepsis.


METHODS
A review of the case notes and microbiologic records of all cases of ESCaPPM bacteremia and meningitis managed at a tertiary children's hospital during a 6-year period.


RESULTS
Fifty-eight cases were identified, and in three (5%) cases beta-lactam resistance emerged during treatment, with adverse clinical consequences in two cases. Clinical and microbiologic outcome was similar in those treated with carbapenems and in those treated with a beta-lactam and aminoglycoside combination. Cefotaxime resistance was found in 57, 30, 24 and 7% of children who had received carbapenems, cephalosporins, penicillins or no/other antimicrobials in the month before ESCaPPM sepsis, respectively.


CONCLUSIONS
The emergence of beta-lactam resistance during treatment of ESCaPPM sepsis is uncommon in our hospital but can have adverse consequences. Where isolates are reported as susceptible to both classes of drugs, an extended spectrum penicillin in combination with an aminoglycoside may be preferable first line treatment of ESCaPPM sepsis to a carbapenem or quinolone.
Boyle
Robert J
RJ
Department of Paediatrics, Murdoch Children's Research Institute, Melbourne University, Melbourne, Victoria, Australia. BobBoyle@doctors.org.uk.
Curtis
Nigel
N
Kelly
Nigel
N
Garland
Susan M
SM
Carapetis
Jonathan R
JR
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism*
D000900:Anti-Bacterial Agents; D001618:beta-Lactamases