title: Aminoglycoside therapy for childhood urinary tract infection due to extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae.
abstract: BACKGROUND
  The rate of urinary tract infections (UTIs) due to extended-spectrum β-lactamase (ESBL)-producing bacterial strains requiring carbapenem therapy has been increasing in children. This study was conducted to evaluate the effect of non-carbapenem antibiotic therapy on childhood UTIs caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae.
  
  
  METHODS
  Medical records of children diagnosed with febrile UTIs due to E. coli or K. pneumoniae between 2010 and 2014 were retrospectively reviewed. The enrolled children were divided into two groups: the ESBL group and the non-ESBL group. Clinical characteristics and therapeutic responses were compared between the two groups.
  
  
  RESULTS
  A total of 211 episodes of UTI (204 caused by E. coli; seven caused by K. pneumoniae) were identified in 205 children. Twenty-two (10.4 %) episodes were categorized into the ESBL group. There was no significant difference in the type of antibiotic administered between the two groups. No carbapenems were administered; however, aminoglycosides were administered for 79.1 % of the total episodes. Although empirical antibiotics were appropriate for more episodes in the non-ESBL group compared with the ESBL group (100.0 % vs. 90.9 %, p = 0.011), there were no significant differences in the frequency of defervescence, bacterial eradication from the urine, acute pyelonephritis and vesicoureteral reflux or fever duration between the two groups.
  
  
  CONCLUSIONS
  Non-carbapenem antibiotics showed favourable therapeutic effects on childhood UTIs caused by ESBL-producing strains. Aminoglycosides can be an alternative to carbapenems in such cases.
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. beomsid@catholic.ac.kr.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. beomsid@catholic.ac.kr.
authors.forename: Seung Beom
authors.initials: SB
authors.lastname: Han
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. erdc87@naver.com.
authors.forename: Sung Chul
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. sylee@catholic.ac.kr.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. sylee@catholic.ac.kr.|Department of Pediatrics, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Dongsu-ro 56, Bupyeong-gu, Incheon, 403-720, Republic of Korea. sylee@catholic.ac.kr.
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. dcjeong@catholic.ac.kr.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. dcjeong@catholic.ac.kr.
authors.forename: Dae Chul
authors.initials: DC
authors.lastname: Jeong
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. kjhan@catholic.ac.kr.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. kjhan@catholic.ac.kr.
authors.forename: Jin Han
authors.initials: JH
authors.lastname: Kang
mesh_terms: D000617:Aminoglycosides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000378:metabolism / Q000472:pathogenicity; D008297:Male; D008826:Microbial Sensitivity Tests; D011704:Pyelonephritis / Q000188:drug therapy / Q000382:microbiology; D056910:Republic of Korea; D012189:Retrospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D056689:Uropathogenic Escherichia coli / Q000187:drug effects* / Q000378:metabolism / Q000472:pathogenicity; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases