Initial empirical antibiotics of non-carbapenems for ESBL-producing E. coli and K. pneumoniae bacteremia in children: a retrospective medical record review

• Published in: BMC infectious diseases Vol. 22; no. 1; p. 866
• Main Authors: Park, Saera, So, HyeJin, Kim, Mi-Na, Lee, Jina
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21.11.2022; BioMed Central; BMC
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Bacteremia; Bacteremia - microbiology; Beta lactamases; Carbapenem; Carbapenems; Carbapenems - therapeutic use; Child; Child, Preschool; Children; Comorbidity; Complications and side effects; Confidence intervals; Diagnostic tests; Dosage and administration; Drug therapy; E coli; Empirical analysis; Empirical antibiotics; ESBL producers; Escherichia coli; Escherichia coli infections; Health care facilities; Hospitals; Humans; Impact analysis; Klebsiella; Klebsiella pneumoniae; Laboratories; Medical Records; Meningitis; Meropenem; Microorganisms; Mortality; Pathogens; Patient outcomes; Patients; Pediatric research; Pediatrics; Pneumonia; Public health; Regression analysis; Retrospective Studies; Risk analysis; Risk factors; Statistical analysis; Sterility; Urinary tract infections; β Lactamase; South Korea; United States > US; Carbapenem; Empirical antibiotics; ESBL producers; Children; Bacteremia
• DOI: 10.1186/s12879-022-07881-7
• ISSN: 1471-2334

The efficacy of non-carbapenems as an empirical antibiotic for extended-spectrum β-lactamases (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia in children remains controversial. We compared clinical and microbial outcomes according to the types of empirical antibiotics for treating pediatric patients with ESBL-producing E. coli and K. pneumoniae bacteremia. Data from pediatric patients aged ≤ 18 years who were hospitalized with monomicrobial ESBL-producing E. coli or K. pneumoniae bacteremia at Asan Medical Center Children's Hospital, Seoul, Korea between January 2014 and May 2019 were analyzed retrospectively. The impact of empirical therapy was assessed as 30-day all-cause mortality and 2-day microbiological outcomes evaluated by the sterility of blood cultures collected on day 2 after empirical antibiotic administration. Logistic regression analysis was used to control for the effects of confounding variables. A total of 53 patients with bacteremia caused by ESBL-producing E. coli (n = 29) and K. pneumoniae (n = 24) were included in this study; the median age was 3.6 years, and all had underlying comorbidities. As empirical antibiotics, 27 patients were treated with meropenem, and non-carbapenem agents were administered to 26 patients; 84.6% (22/26) were converted to carbapenem antibiotics as the definitive antibiotic by day 2 after empirical antibiotic administration. Overall, the 30-day all-cause mortality of ESBL-producing E. coli and K. pneumoniae bacteremia was 17.0% (9/53). After adjustment, there was no statistically significant association of use of a non-carbapenem agent as an empirical antibiotic with microbiological failure on day 2 and 30-day all-cause mortality [adjusted odds ratio (OR) 1.0; 95% confidence interval (CI) 0.22-4.88, and adjusted OR 0.1; 95% CI 0.01-1.56]. The empirical use of non-carbapenems might not be a risk factor for mortality and early microbiological outcomes in pediatric patients with ESBL-producing E. coli and K. pneumoniae BSI if early transition to appropriate antimicrobial therapy was possible.