Outcome of Antimicrobial Therapy of Pediatric Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae.
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.


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.
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
Bongjin
B
Lee
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
Soo Young
SY
Kang
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
Hyun Mi
HM
Kang
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
Nu Ri
NR
Yang
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea. ; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Hee Gyung
HG
Kang
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea. ; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Il Soo
IS
Ha
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea. ; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Hae Il
HI
Cheong
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea. ; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Hoan Jong
HJ
Lee
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea. ; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Eun Hwa
EH
Choi
Enterobacteriaceae; Extended-spectrum β-lactamase; carbapenem; children; urinary tract infections