Febrile urinary-tract infection due to extended-spectrum beta-lactamase–producing Enterobacteriaceae in children: A French prospective multicenter study

Abstract

ObjectivesTo assess the management of febrile urinary-tract infection (FUTIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E) in children, the Pediatric Infectious Diseases Group of the French Pediatric Society set up an active surveillance network in pediatric centers across France in 2014.Materials and methodsWe prospectively analysed data from 2014 to 2016 for all children < 18 years old who received antibiotic treatment for FUTI due to ESBL-E in 24 pediatric centers. Baseline demographic, clinical features, microbiological data and antimicrobials prescribed were collected.Results301 children were enrolled in this study. The median age was 1 year (IQR 0.02–17.9) and 44.5% were male. These infections occurred in children with history of UTIs (27.3%) and urinary malformations (32.6%). Recent antibiotic use was the main associated factor for FUTIs due to ESBL-E, followed by a previous hospitalization and travel history. Before drug susceptibility testing (DST), third-generation cephalosporins (3GC) PO/IV were the most-prescribed antibiotics (75.5%). Only 13% and 24% of children received amikacine alone for empirical or definitive therapy, respectively, whereas 88.7% of children had isolates susceptible to amikacin. In all, 23.2% of children received carbapenems in empirical and/or definitive therapy. Cotrimoxazole (24.5%), ciprofloxacin (15.6%) and non-orthodox clavulanate–cefixime combination (31.3%) were the most frequently prescribed oral options after obtaining the DST. The time to apyrexia and length of hospital stay did not differ with or without effective empirical therapy.ConclusionsWe believe that amikacin should increasingly take on a key role in the choice of definitive therapy of FUTI due to ESBL-E in children by avoiding the use of carbapenems.

Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal

“…It has been estimated that around 50% of UTI in children are missed [2, 6]. Timely diagnosis and targeted treatment decrease the risk of renal scarring and other complications [7, 8]. For this purpose, empirical antibiotic is often prescribed even before the culture results are available.…”

Infeções Urinárias Causadas por Enterobacteriaceae Produtoras de β-Lactamases de Espetro Expandido Adquiridas na Comunidade num Hospital de Nível III - Um Estudo Retrospetivo

“…Os aminoglicosídeos têm demonstrado eficácia variável, sendo o mais promissor a amicacina. 44 Um estudo retrospetivo realizado de 2015 a 2016, que incluiu crianças dos dois aos 18 anos com cistites causadas por estirpes de E. coli produtoras de ESBL-AC, concluiu que a cura clínica ocorreu em 96% (n = 51/53) dos casos. 45 Uma análise retrospetiva realizada na Coreia do Sul, verificou que não existiam diferenças estatisticamente significativas entre as crianças com IU por Enterobacteriaceae produtoras de ESBL tratadas com antibióticos não-carbapenemos (cefotaxima, piperacilina-tazobactan e amicacina) e com carbapenemos.…”

Urinary Tract Infection (UTI) Still a Force to be Reckoned with

“…Thus urine culture should be performed as screening and diagnostic tool of UTI in pregnancy in this setting. (38) UTIs vary greatly by clinical presentation and therapeutic management.Urinary tract infections affect a variety of patients with different biological and procedural risk factors (e.g., age, sex, pregnancy, catheters and urologic interventions). However, not all bacteriurias require antibiotic therapy, particularly in the presence of ASB.…”