RESEARCH ARTICLE


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
1 Pediatric Infectious Diseases, University of Texas at Austin Dell Medical School, Dell Children’s Medical Center of Central Texas, Austin, TX, USA
2 Pediatric Infectious Diseases, Dell Children’s Medical Center of Central Texas, Austin, TX, USA
3 Department of Pharmacy, Dell Children’s Medical Center of Central Texas, Austin, TX, USA
4 Clinical Quality and Operational Effectiveness, Dell Children’s Medical Center of Central Texas, Austin, TX, USA
5 Infection Control Preventionist, Dell Children’s Medical Center of Central Texas, Austin, TX, USA

Article Information


Identifiers and Pagination:

Year: 2018
Volume: 10
First Page: 9
Last Page: 14
Publisher Id: TOIDJ-10-9
DOI: 10.2174/1874279301810010009

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

© 2018 Fernandez et al.

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.

* 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, rdquick@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.

Keywords: Extended-Spectrum β-Lactamase (ESBL), Carbapenem-Sparing, Piperacillin-tazobactam, Sulfamethoxazole-trimethoprim, Ciprofloxacin, Amoxicillin-clavulanate.