Pediatric extended spectrum β‐lactamase infection: Community‐acquired infection and treatment options

Sethaphanich, Napapailin; Santanirand, Pitak; Rattanasiri, Sasivimol; Techasaensiri, Chonnamet; Chaisavaneeyakorn, Sujittra; Apiwattanakul, Nopporn

doi:10.1111/ped.12845

Cited by 13 publications

(5 citation statements)

References 27 publications

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“…They also found the vast majority of ESBL-producing isolates were susceptible to amikacin but noted that poor tissue penetration and potential nephrotoxicity limited the use of amikacin and other aminoglycosides outside of urinary tract infections. 40 Another potential treatment option is piperacillin/tazobactam, but we found substantial non-susceptibility (> 25%) to this combination among ESBL-producing K. pneumoniae isolates, similar to Sethaphanich, 39 who found only 62.6% of K. pneumoniae isolates were susceptible to piperacillin/tazobactam. This makes it a poor choice for empiric treatment.…”

Section: Discussionsupporting

confidence: 70%

“…We found a high prevalence of resistance to third-generation cephalosporins among ESBL-producing E. coli and K. pneumoniae , which is consistent with previous reports from Thailand. 38 A 2016 report 39 examined treatment options for children (0–15 years) with E. coli and K. pneumonia e infections visiting a tertiary care center in Bangkok. They also found the vast majority of ESBL-producing isolates were susceptible to amikacin but noted that poor tissue penetration and potential nephrotoxicity limited the use of amikacin and other aminoglycosides outside of urinary tract infections.…”

Section: Discussionmentioning

confidence: 99%

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High Burden of Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella pneumoniae Bacteremia in Older Adults: A Seven-Year Study in Two Rural Thai Provinces

Sawatwong

Sapchookul

Whistler

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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. Bloodstream infection surveillance conducted from 2008 to 2014 in all 20 hospitals in Sa Kaeo and Nakhon Phanom provinces, Thailand, allowed us to look at disease burden, antibiotic susceptibilities, and recurrent infections caused by extended-spectrum β-lactamase (ESBL)–producing Escherichia coli and Klebsiella pneumoniae . Of 97,832 blood specimens, 3,338 were positive for E. coli and 1,086 for K. pneumoniae . The proportion of E. coli isolates producing ESBL significantly increased from 19% to 22% in 2008–2010 to approximately 30% from 2011 to 2014 ( P -value for trend = 0.02), whereas ESBL production among K. pneumoniae cases was 27.4% with no significant trend over time. Incidence of community-onset ESBL-producing E. coli increased from 5.4 per 100,000 population in 2008 to 12.8 in 2014, with the highest rates among persons aged ≥ 70 years at 79 cases per 100,000 persons in 2014. From 2008 to 2014, community-onset ESBL-producing K. pneumoniae incidence was 2.7 per 100,000, with a rate of 12.9 among those aged ≥ 70 years. Although most (93.6% of E. coli and 87.6% of K. pneumoniae ) infections were community-onset, hospital-onset infections were twice as likely to be ESBL. Population-based surveillance, as described, is vital to accurately monitor emergence and trends in antimicrobial resistance, and in guiding the development of rational antimicrobial therapy recommendations.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

High Burden of Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella pneumoniae Bacteremia in Older Adults: A Seven-Year Study in Two Rural Thai Provinces

Sawatwong

Sapchookul

Whistler

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…pneumoniae was the most frequent (44.8%) causes of infections in children under 5 years of age. However, comparatively low prevalence of ESBL (40%) was reported in paediatric infection in Thailand [19]. Therefore, children infected with Enterobacteriaceae species need a great emphasis prior to selection of antimicrobial therapy.…”

Section: Discussionmentioning

confidence: 99%

Extended-Spectrum beta (β)-Lactamases and Antibiogram in Enterobacteriaceae from Clinical and Drinking Water Sources from Bahir Dar City, Ethiopia

2016

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BackgroundThe spread of Extended-Spectrum beta (β)-Lactamases (ESBL)-producing Enterobacteriaceae has become a serious global problem. ESBL-producing Enterobacteriaceae vary based on differences in antibiotic use, nature of patients and hospital settings. This study was aimed at determining ESBL and antibiogram in Enterobacteriaceae isolates from clinical and drinking water sources in Bahir Dar City, Northwest Ethiopia.MethodsEnterobacteriaceae species were isolated from clinical materials and tap water using standard culturing procedures from September 2013 to March 2015. ESBL-producing-Enterobacteriaceae were detected using double-disk method by E-test Cefotaxim/cefotaxim+ clavulanic acid and Ceftazidime/ceftazidime+ clavulanic acid (BioMerieux SA, France) on Mueller Hinton agar (Oxoid, UK).ResultsOverall, 274 Enterobacteriaceae were isolated. Of these, 210 (44%) were from patients and 64 (17.1%) were from drinking water. The median age of the patients was 28 years. Urinary tract infection and blood stream infection accounted for 60% and 21.9% of Enterobacteriaceae isolates, respectively. Klebsiella pneumoniae was isolated from 9 (75%) of neonatal sepsis. The overall prevalence of ESBL-producing Enterobacteriaceae in clinical and drinking water samples were 57.6% and 9.4%, respectively. The predominant ESBL-producers were K. pneumoniae 34 (69.4%) and Escherichia coli 71 (58.2%). Statistically significant associations were noted between ESBL-producing and non- producing Enterobacteriaceae with regard to age of patients, infected body sites and patient settings (P = 0.001). ESBL-producing Enterobacteriaceae showed higher levels of resistance against chloramphenicol, ciprofloxacin and cotrimoxazole than non-ESBL producers (P = 0.001)ConclusionsESBL-producing Enterobacteriaceae coupled with high levels of other antimicrobials become a major concern for treatment of patients with invasive infections such as blood stream infections, neonatal sepsis and urinary tract infections. ESBL-producing Enterobacteriaceae were also detected in drinking water sources.

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“… 12 A recent study of isolates from pediatric participants found that apart from cephalosporins, ESBL-producing strains of E. coli and K. pneumoniae were less likely to be susceptible to other antibacterial agents, such as amoxicillin/clavulanic acid, quinolones, gentamicin, netilmicin, and cotrimoxazole. 20 Thus, having options that are effective against these multidrug-resistant organisms, such as ceftolozane/tazobactam, is important.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Ceftolozane/Tazobactam Plus Metronidazole Versus Meropenem From a Phase 2, Randomized Clinical Trial in Pediatric Participants With Complicated Intra-abdominal Infection

Jackson¹,

Newland

Dementieva

et al. 2023

Pediatric Infectious Disease Journal

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Background: Ceftolozane/tazobactam, a cephalosporin-β-lactamase inhibitor combination, is approved for the treatment of complicated urinary tract infections and complicated intra-abdominal infections (cIAI). The safety and efficacy of ceftolozane/tazobactam in pediatric participants with cIAI were assessed. Methods: This phase 2 study (NCT03217136) randomized participants to either ceftolozane/tazobactam+metronidazole or meropenem for treatment of cIAI in pediatric participants (<18 years). The primary objective was to assess the safety and tolerability of intravenous ceftolozane/ tazobactam+metronidazole. Clinical cure at end of treatment (EOT) and test of cure (TOC) visits were secondary end points. Results:The modified intent-to-treat (MITT) population included 91 participants (ceftolozane/tazobactam+metronidazole, n = 70; meropenem, n = 21). Complicated appendicitis was the most common diagnosis (93.4%); Escherichia coli was the most common pathogen (65.9%).Adverse events (AEs) occurred in 80.0% and 61.9% of participants receiving ceftolozane/tazobactam+metronidazole and meropenem, drug-related AEs occurred in 18.6% and 14.3% and serious AEs occurred in 11.4% and 0% of participants receiving ceftolozane/tazobactam+metronidazole and meropenem, respectively. No drug-related serious AEs or discontinuations due to drug-related AEs occurred. Rates of the clinical cure for ceftolozane/tazobactam+metronidazole and meropenem at EOT were 80.0% and 95.2% (difference: −14.3; 95% confidence interval: −26.67 to 4.93) and at TOC were 80.0% and 100.0% (difference: −19.1; 95% confidence interval: −30.18 to −2.89), respectively; 6 of the 14 clinical failures for ceftolozane/ tazobactam+metronidazole at TOC were indeterminate responses imputed as failures per protocol. Conclusion: Ceftolozane/tazobactam+metronidazole was well tolerated in pediatric participants with cIAI and had a safety profile similar to the established safety profile in adults. In this descriptive efficacy analysis, ceftolozane/tazobactam+metronidazole appeared efficacious.

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Pediatric extended spectrum β‐lactamase infection: Community‐acquired infection and treatment options

Cited by 13 publications

References 27 publications

High Burden of Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella pneumoniae Bacteremia in Older Adults: A Seven-Year Study in Two Rural Thai Provinces

High Burden of Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella pneumoniae Bacteremia in Older Adults: A Seven-Year Study in Two Rural Thai Provinces

Extended-Spectrum beta (β)-Lactamases and Antibiogram in Enterobacteriaceae from Clinical and Drinking Water Sources from Bahir Dar City, Ethiopia

Safety and Efficacy of Ceftolozane/Tazobactam Plus Metronidazole Versus Meropenem From a Phase 2, Randomized Clinical Trial in Pediatric Participants With Complicated Intra-abdominal Infection

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