Carbapenem-Sparing Antibiotic Treatment Options in Children with Extended-Spectrum β-Lactamase (ESBL) Producing Bacteria
Marisol Fernandez1, Rachel D. Quick2, *, Kathryn G. Merkel3, Sarah Casey2, Patrick Boswell4, Ann Bailey5, Sarmistha B. Hauger1
Identifiers and Pagination:Year: 2018
First Page: 9
Last Page: 14
Publisher Id: TOIDJ-10-9
Article History:Received Date: 30/11/2017
Revision Received Date: 19/03/2018
Acceptance Date: 26/03/2018
Electronic publication date: 18/04/2018
Collection year: 2018
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This is a single-site retrospective chart review study that sought to assess risk factors associated with antibiotic resistance and the likelihood of susceptibility to non-carbapenem antibiotics in ESBL-producing bacteria in positive cultures in pediatric patients.
Materials and methods:
ESBL-producing bacteria were present in 222 culture-positive cases. Among 177 isolates tested, 85.9% had susceptible breakpoint to piperacillin-tazobactam. Aminoglycoside susceptibility varied with low percentages among tobramycin and gentamicin (36.9% and 50.9%, respectively), but high susceptibility for amikacin (95.5%). Most isolates (77%) were susceptible to at least one oral option, but individual susceptibilities were low. Risk factors associated with ESBL acquisition were not independently associated with antibiotic resistance to amikacin, piperacillin-tazobactam, or combined oral options, sulfamethoxazole-trimethoprim, ciprofloxacin, and amoxicillin-clavulanate.
When determining empiric treatment, for an isolate identified as ESBL prior to finalized susceptibilities, piperacillin-tazobactam may be a carbapenem-sparing antibiotic option to consider based on local resistance data. Oral antibiotic options may be appropriate in non-critical patients.