Pediatric extended spectrum [beta]-lactamase infection: Community-acquired infection and treatment options

• Published in: Pediatrics international 2016-05, Vol.58 (5), p.338
• Main Authors: Sethaphanich, Napapailin, Santanirand, Pitak, Rattanasiri, Sasivimol, Techasaensiri, Chonnamet, Chaisavaneeyakorn, Sujittra, Apiwattanakul, Nopporn
• Format: Article
• Language: English
• Subjects: Antibiotics; Human papillomavirus; Infections; Pediatrics
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.12845

Background Infection caused by extended spectrum [beta]-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. Conclusion 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.