Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 21;22(1):866.
doi: 10.1186/s12879-022-07881-7.

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

Saera Park  1 , HyeJin So  1 , Mi-Na Kim  2 , Jina Lee  3
Affiliations

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

Saera Park et al. BMC Infect Dis. .

Abstract

Background: 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.

Methods: 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.

Results: 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].

Conclusions: 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.

Keywords: Bacteremia; Carbapenem; Children; ESBL producers; Empirical antibiotics.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient inclusion flowchart
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268–281. doi: 10.1111/j.1469-0691.2011.03570.x. - DOI - PubMed
    1. Makharita RR, El-Kholy I, Hetta HF, Abdelaziz MH, Hagagy FI, Ahmed AA, et al. Antibiogram and genetic characterization of carbapenem-resistant gram-negative pathogens incriminated in healthcare-associated infections. Infect Drug Resist. 2020;13:3991. doi: 10.2147/IDR.S276975. - DOI - PMC - PubMed
    1. Carvalho I, Carvalho JA, Martínez-Álvarez S, Sadi M, Capita R, Alonso-Calleja C, et al. Characterization of ESBL-producing Escherichia coli and Klebsiella pneumoniae Isolated from clinical samples in a Northern Portuguese Hospital: predominance of CTX-M-15 and high genetic diversity. Microorganisms. 2021;9(9):1914. doi: 10.3390/microorganisms9091914. - DOI - PMC - PubMed
    1. Arana DM, Sánchez A, Bautista V, Oteo-Iglesias J, Alós J-I. ESBL-producing-multidrug resistant E. coli population from urinary tract infections is less diverse than non-ESBL-multidrug resistant population. Enferm Infecc Microbiol Clin. 2019;37(10):652–655. doi: 10.1016/j.eimc.2019.02.008. - DOI - PubMed
    1. Ko KS, Yeom J-S, Lee MY, Peck KR, Song J-H. Clonal dissemination of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae isolates in a Korean hospital. J Korean Med Sci. 2008;23(1):53–60. doi: 10.3346/jkms.2008.23.1.53. - DOI - PMC - PubMed