title: Empiric Monotherapy Versus Combination Therapy for Enterobacteriaceae Bacteremia in Children.
abstract: BACKGROUND
  Bacteremia caused by members of the Enterobacteriaceae can be life threatening. Appropriate antimicrobial therapy is critical to reducing morbidity and mortality.
  
  
  METHODS
  This retrospective cohort study (2008-2011) was conducted in children and young adults (<21 years of age) hospitalized with Enterobacteriaceae bacteremia with clinical signs and symptoms of infection. We investigated whether combination empiric antimicrobial therapy was superior to monotherapy for treatment. Monotherapy was defined as empiric therapy with a β-lactam agent alone. Combination therapy was defined as coadministration of a β-lactam agent with an aminoglycoside agent for at least 48 hours before the susceptibility data were known. Outcome was measured as the response to therapy (defined as the time to negative blood culture) and was compared among patients administered monotherapy versus combination therapy.
  
  
  RESULTS
  Of 203 episodes of Enterobacteriaceae bacteremia, 78 (38%) were caused by Klebsiella spp, 73 (36%) were caused by Escherichia coli, and 52 (26%) were caused by Enterobacter spp. Of 203 episodes of bacteremia caused by 3 organisms of greatest interest, 101 (50%) were treated with combination therapy. Patients with cancer were more likely to receive combination therapy (38% vs. 16%; P < 0.001); patients with gastrointestinal disease and those receiving total parenteral nutrition were more likely to receive monotherapy (58% vs. 39%; P = 0.006 and 54% vs. 37%; P = 0.013, respectively). There was no difference in outcome in patients receiving monotherapy versus combination therapy (P = 0.86).
  
  
  CONCLUSIONS
  Combination therapy consisting of a β-lactam agent and an aminoglycoside agent was not superior to monotherapy with a β-lactam agent alone for managing Enterobacteriaceae bacteremia in children and young adults.
authors: From the *Department of Epidemiology, School of Public Health, The George Washington University, Washington, DC; †Division of Critical Care Medicine, ‡Division of Infectious Diseases, Children's National Medical Center, Washington, DC; §Department of Pediatrics, ¶Department of Microbiology/Immunology/Tropical Medicine, and **Department of Pathology, School of Medicine, The George Washington University, Washington, DC.
authors: Nina M
authors: NM
authors: Berkowitz
authors: Michael C
authors: MC
authors: Spaeder
authors: Roberta L
authors: RL
authors: DeBiasi
authors: Joseph
authors: J
authors: Campos
authors: Nalini
authors: N
authors: Singh
mesh_terms: D000293:Adolescent; D000617:Aminoglycosides / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000379:methods; D004755:Enterobacteriaceae / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D047090:beta-Lactams / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D047090:beta-Lactams