The Open Infectious Diseases Journal
2018, 10 : 9-14Published online 2018 April 18. DOI: 10.2174/1874279301810010009
Publisher ID: TOIDJ-10-9
RESEARCH ARTICLE
Carbapenem-Sparing Antibiotic Treatment Options in Children with Extended-Spectrum β-Lactamase (ESBL) Producing Bacteria
2 Pediatric Infectious Diseases, , ,
3 Department of Pharmacy, , ,
4 Clinical Quality and Operational Effectiveness, , ,
5 Infection Control Preventionist, , ,
* Address correspondence to this author at the Pediatric Infectious Diseases, University of Texas at Austin Dell Medical School, Dell Children’s Medical Center of Central Texas, 4900 Mueller Blvd, Austin TX 78723, TX, USA; Tel: 512-628-1820; Fax: 512-628-2258; E-mails: , mxfernandez@ascension.org
ABSTRACT
Introduction:
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.
Conclusion:
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.