Extended‐spectrum <i>β</i>‐lactamase‐producing bacteria caused less than 5% of urinary tract infections in a paediatric emergency centre

Jacmel, L.; Timsit, Sandra; Ferroni, Agnès; Auregan, Clémentine; Angoulvant, François; Chéron, G.

doi:10.1111/apa.13546

Cited by 9 publications

(6 citation statements)

References 27 publications

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“…A high rate of antibiotic resistance for E. coli strains, in particular, has been identified in Europe and North America ( 8 , 16 , 17 ). Urinary E. coli expressing ESBLs in Asia has already reached about 60% ( 18 , 19 ), but remains fortunately low in Europe ( 13 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

Prospective Cohort Study Investigating the Safety and Efficacy of Ambulatory Treatment With Oral Cefuroxime-Axetil in Febrile Children With Urinary Tract Infection

Hennaut¹,

Duong²,

Chiodini³

et al. 2018

Front. Pediatr.

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Aims: To assess the safety and efficacy of ambulatory oral cefuroxime-axetil treatment in children presenting with first febrile urinary tract infection (UTI) in terms of resolution of fever, antibiotics tolerance, bacterial resistance, and loss to ambulatory follow-up.Methods: Two-year prospective single-center evaluation of the local protocol of oral ambulatory treatment of children presenting first febrile urinary tract infection (UTI).Results: From October 2013 to October 2015, 82 children were treated ambulatory with oral cefuroxime-axetil. The median age was 8 months. When analyzing those 82 children treated orally, 51 (62%) completed oral treatment, 14 (17%) missed their scheduled follow-up visits (3 patients at day 2 and 11 patients at week 2), and 17 (21%) were switched to IV therapy for the following reasons: vomiting in 9, persistent fever in 5, antibiotic resistance in 2 and bacteremia in 1. Six children (8%) presented recurrent UTI after a median of 5 months of follow-up.Conclusions: This 2-year evaluation suggests that oral treatment with cefuroxime-axetil in febrile UTI is feasible but should be implemented with caution. Home-treated children require reevaluation during treatment since 21% of our cohort had to be temporarily switched to parenteral therapy and 17% did not attend scheduled follow-up visits during oral treatment.

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Section: Discussionmentioning

confidence: 99%

Prospective Cohort Study Investigating the Safety and Efficacy of Ambulatory Treatment With Oral Cefuroxime-Axetil in Febrile Children With Urinary Tract Infection

Hennaut¹,

Duong²,

Chiodini³

et al. 2018

Front. Pediatr.

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“…Contrary to the p values in Table 1, the odds ratios of male gender and chronic diseases as risk factors for ESBL UTIs are not statistically significant, which can be seen from the 95% confidence interval limits of the odds ratios as they include one . Furthermore, Jacmel et al.…”

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confidence: 72%

“…In this issue of Acta Paediatrica , Jacmel et al. report on the occurrence of ESBL among children with urinary tract infections (UTIs) in one French paediatric emergency centre. They found that <5% of UTIs were caused by ESBL‐producing bacteria.…”

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confidence: 99%

Low occurrence of extended spectrum beta‐lactamases in urinary tract infections is reassuring given limited treatment options

Uhari

2016

Acta Paediatrica

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“…The classification of antibiotics was very heterogeneous among selected studies ( Tables S1 and S2 ) [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. Overall antibiotic exposure (i.e., without specifying a drug or class) was analyzed as a risk factor in 77% (36/47) of studies, while cephalosporins, (fluoro)quinolones, and penicillins were frequently individualized, with various sub-classifica...…”

Section: Studies’ Epidemiological Key Points: Challenges Findings And...mentioning

confidence: 99%

From Pathophysiological Hypotheses to Case–Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections

et al. 2022

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Antimicrobial resistance is a global public health concern, at least partly due to the misuse of antibiotics. The increasing prevalence of antibiotic-resistant infections in the community has shifted at-risk populations into the general population. Numerous case–control studies attempt to better understand the link between antibiotic use and antibiotic-resistant community-onset infections. We review the designs of such studies, focusing on community-onset bloodstream and urinary tract infections. We highlight their methodological heterogeneity in the key points related to the antibiotic exposure, the population and design. We show the impact of this heterogeneity on study results, through the example of extended-spectrum β-lactamases producing Enterobacteriaceae. Finally, we emphasize the need for the greater standardization of such studies and discuss how the definition of a pathophysiological hypothesis specific to the bacteria–resistance pair studied is an important prerequisite to clarify the design of future studies.

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Extended‐spectrum β‐lactamase‐producing bacteria caused less than 5% of urinary tract infections in a paediatric emergency centre

Abstract: The prevalence of febrile ESBL urinary tract infections was less than 5% in a paediatric emergency department. This low rate was not high enough to justify changing our guidelines.

Cited by 9 publications

References 27 publications

Prospective Cohort Study Investigating the Safety and Efficacy of Ambulatory Treatment With Oral Cefuroxime-Axetil in Febrile Children With Urinary Tract Infection

Prospective Cohort Study Investigating the Safety and Efficacy of Ambulatory Treatment With Oral Cefuroxime-Axetil in Febrile Children With Urinary Tract Infection

Low occurrence of extended spectrum beta‐lactamases in urinary tract infections is reassuring given limited treatment options

From Pathophysiological Hypotheses to Case–Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections

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