Efficacy of non-carbapenem antibiotics for pediatric patients with first febrile urinary tract infection due to extended-spectrum beta-lactamase-producing Escherichia coli

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2017-08, Vol.23 (8), p.517-522
• Main Authors: Abe, Yoshifusa, Inan-Erdogan, Işil, Fukuchi, Kunihiko, Wakabayashi, Hitomi, Ogawa, Yasuha, Hibino, Satoshi, Sakurai, Shunsuke, Matsuhashi, Kazuhiko, Watanabe, Yoshitaka, Hashimoto, Kaori, Ugajin, Kazuhisa, Itabashi, Kazuo
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; beta-Lactamases; Carbapenems - therapeutic use; Child, Preschool; Children; Escherichia coli; Escherichia coli Infections - drug therapy; Escherichia coli Infections - microbiology; Extended-spectrum beta-lactamase; Female; Fever; Hematology, Oncology and Palliative Medicine; Humans; Infant; Japan - epidemiology; Male; Retrospective Studies; Upper urinary tract infection; Urinary Tract Infections - drug therapy; Urinary Tract Infections - microbiology
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1016/j.jiac.2017.04.006

Abstract Although carbapenem is the recommended for urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms, non-carbapenems have been reported to be effective for adult patients with UTI caused by ESBL-producing organisms. The purpose of this study was to evaluate the efficacy of non-carbapenems for pediatric patients with UTI due to ESBL-producing Escherichia coli ( E. coli ) based on the microbiologic and clinical outcomes. Fifteen children, who were treated for first febrile UTI caused by ESBL-producing E. coli were enrolled in this study. Antimicrobial susceptibilities and ESBL production were determined according to the Clinical and Laboratory Standards Institute guidelines. To detect CTX-M genes, polymerase chain reaction was performed with specific primers for blaCTX-M detection. Of the 15 enrolled patients, 10 (66.7%) were boys and 5 (33.3%) were girls, with a median age of four months. VUR was detected in six patients (40%). For detection of blaCTX-M by PCR, CTX-M-3, CTX-M-8, CTX-M-14, and CTX-M-15 were detected in five, one, eight, and one patient, respectively. Overall, 14 of the 15 isolates (93.3%) were susceptible for fosfomycin (FOM), and all isolates were susceptible for cefmetazole (CMZ), flomoxef (FMOX), and imipenem/cilastatin (IPM/CS). Of the 15 patients, 12 (80%) clinically improved without the use of carbapenems. In conclusion, even if isolates of ESBL-producing E. coli are multidrug resistant based on MIC assessment, clinical susceptibility to non-carbapenems, such as CMZ, FMOX, and FOM, is possible. Accordingly, carbapenems may not be required all the time for treatment of pediatric UTI in clinical practice.