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Observational Study
. 2018 Jan 25;13(1):e0190910.
doi: 10.1371/journal.pone.0190910. eCollection 2018.

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

Fouad Madhi  1   2   3 , Camille Jung  1   4 , Sandra Timsit  5 , Corinne Levy  2   3   4   6 , Sandra Biscardi  2   3   7 , Mathie Lorrot  2   8 , Emmanuel Grimprel  2   9 , Laure Hees  2   10 , Irina Craiu  2   11 , Aurelien Galerne  2   12 , François Dubos  2   13 , Emmanuel Cixous  2   14 , Véronique Hentgen  2   15 , Stéphane Béchet  5 ; Urinary-tract Infection due to Extended-Spectrum Beta-lactamase–producing Enterobacteriaceae in Children Group; Stéphane Bonacorsi  16 , Robert Cohen  2   3   4   6   17
Affiliations
Observational Study

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

Fouad Madhi et al. PLoS One. .

Abstract

Objectives: To 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 methods: We 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.

Results: 301 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.

Conclusions: We 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Frequency of ESBL-producing Enterobacteriaceae in urine in each microbiology center between 2014 and 2016.
C, center.
Fig 2
Fig 2. Time to apyrexia.
Kaplan-Meier estimates of time to apyrexia in patients with effective and ineffective empirical treatment.
Fig 3
Fig 3. Length of hospital stay.
Kaplan-Meier estimates of length of hospital stay in patients with effective and ineffective empirical treatment.
See this image and copyright information in PMC

References

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