title: Pediatric extended spectrum β-lactamase infection: Community-acquired infection and treatment options.
abstract: BACKGROUND
  Infection caused by extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in pediatric patients has been increasing and spreading to the community, compromising the options for effective antibiotics. This retrospective study was conducted to identify which antibiotics ESBL-producing Enterobacteriaceae remain susceptible to. In addition, the prevalence of community-acquired infection caused by these organisms, and the possibility of association between these organisms and septic shock, were explored.
  
  
  METHODS
  Antibiotic susceptibility of ESBL-producing and non-ESBL-producing Escherichia coli and Klebsiella pneumoniae strains isolated from pediatric patients were reviewed to determine the rates of susceptibility to various antibiotics. A chart review was performed to clarify the prevalence of community-acquired infection and the severity.
  
  
  RESULTS
  Of 849 strains analyzed, 40% were ESBL positive. Apart from cephalosporins, ESBL-producing strains were also less likely to be susceptible to other antibiotics, such as quinolones, gentamicin, netilmicin, and cotrimoxazole, more than 90% of which were still susceptible to amikacin, carbapenems, colistin, and tigecycline. Around 20% of community-acquired infections in the present study were caused by ESBL-producing strains. ESBL-producing strains found in the community were more likely to be susceptible to gentamicin, netilmicin, and cefepime than those found in hospital. Infection caused by ESBL-producing strains was not significantly associated with septic shock.
  
  
  CONCLUSIONS
  The increase in infection caused by ESBL-producing Enterobacteriaceae limits the availability of effective antibiotics. Given that carbapenems are necessary for treating serious infections, amikacin, cefepime, and piperacillin/tazobactam are possible options for consolidative therapy or for non-serious infection.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Napapailin
authors.initials: N
authors.lastname: Sethaphanich
authors.affiliation: Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Pitak
authors.initials: P
authors.lastname: Santanirand
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Sasivimol
authors.initials: S
authors.lastname: Rattanasiri
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Chonnamet
authors.initials: C
authors.lastname: Techasaensiri
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Sujittra
authors.initials: S
authors.lastname: Chaisavaneeyakorn
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Nopporn
authors.initials: N
authors.lastname: Apiwattanakul
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy / Q000382:microbiology; D013785:Thailand / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D015415:Biomarkers; D001618:beta-Lactamases
keywords: Enterobacteriaceae; community-acquired infection; drug resistance; prevalence; β-lactamase