Lee Bongjin, Kang Soo Young, Kang Hyun Mi, Yang Nu Ri, Kang Hee Gyung, Ha Il Soo, Cheong Hae Il, Lee Hoan Jong, Choi Eun Hwa
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea. ; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Infect Chemother. 2013 Dec;45(4):415-21. doi: 10.3947/ic.2013.45.4.415. Epub 2013 Dec 27.
The purpose of this study was to compare the outcome of carbapenem versus non-carbapenem antimicrobial therapy for pediatric urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae.
From 2006 to 2011, 42 episodes of UTI caused by ESBL-producing Enterobacteriaceae were diagnosed at Seoul National University Children's Hospital. Patients were grouped according to the antimicrobials they received into a carbapenem group and a non-carbapenem group. Medical records were retrospectively reviewed to assess treatment outcome, time to defervescence after initiation of treatment, and relapse rate.
There were 36 children with 42 episodes of UTI caused by ESBL-producing Enterobacteriaceae. Twenty-seven cases (64%) had an underlying urologic disease, 28 (67%) cases were caused by Escherichia coli, and 14 (33%) cases were caused by Klebsiella pneumoniae. Four (10%) cases were treated with carbapenem, 23 cases (55%) were treated with non-carbapenem, and 15 (36%) cases were treated by switching from a carbapenem to a non-carbapenem and vice versa. There was no treatment failure at the time of antimicrobial discontinuation. Between the carbapenem and the non-carbapenem treatment groups, there were no significant differences in bacterial etiology (P = 0.59), time to defervescence after the initiation of antimicrobials (P = 0.28), and relapse rate (P = 0.50). In vitro susceptibility to non-carbapenem antimicrobials did not affect the time to defervescence after the initiation of antimicrobial treatment, and the relapse rate in the non-carbapenem group.
This study found no significant difference in the treatment outcome between pediatric patients treated with carbapenem and those treated with non-carbapenem antimicrobials for UTI caused by ESBL-producing Enterobacteriaceae. Therefore, the initially administered non-carbapenem can be maintained in UTI patients showing clinical improvement.
本研究旨在比较碳青霉烯类与非碳青霉烯类抗菌药物治疗由产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌引起的小儿尿路感染（UTI）的疗效。
2006年至2011年期间，首尔国立大学儿童医院诊断出42例由产ESBL的肠杆菌科细菌引起的UTI。根据患者接受的抗菌药物将其分为碳青霉烯类组和非碳青霉烯类组。对病历进行回顾性分析，以评估治疗效果、开始治疗后体温恢复正常的时间以及复发率。
36名儿童发生了42例由产ESBL的肠杆菌科细菌引起的UTI。27例（64%）有潜在泌尿系统疾病，28例（67%）由大肠埃希菌引起，14例（33%）由肺炎克雷伯菌引起。4例（10%）接受碳青霉烯类治疗，23例（55%）接受非碳青霉烯类治疗，15例（36%）先接受碳青霉烯类治疗后换用非碳青霉烯类治疗或反之。停用抗菌药物时无治疗失败情况。碳青霉烯类治疗组与非碳青霉烯类治疗组在细菌病因（P = 0.59）、开始使用抗菌药物后体温恢复正常的时间（P = 0.28）以及复发率（P = 0.50）方面无显著差异。对非碳青霉烯类抗菌药物的体外敏感性不影响开始抗菌治疗后体温恢复正常的时间以及非碳青霉烯类组的复发率。
本研究发现，对于由产ESBL的肠杆菌科细菌引起的UTI，接受碳青霉烯类治疗的小儿患者与接受非碳青霉烯类抗菌药物治疗的小儿患者在治疗效果上无显著差异。因此，对于临床症状有改善的UTI患者，可维持最初使用的非碳青霉烯类药物治疗。
