Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
BMC Infect Dis. 2022 Nov 21;22(1):866. doi: 10.1186/s12879-022-07881-7.
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.
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.
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].
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.
对于产超广谱β-内酰胺酶（ESBL）的大肠埃希菌和肺炎克雷伯菌菌血症，非碳青霉烯类药物作为经验性抗生素的疗效仍存在争议。我们比较了不同经验性抗生素治疗产 ESBL 的大肠埃希菌和肺炎克雷伯菌菌血症患儿的临床和微生物学结局。
回顾性分析 2014 年 1 月至 2019 年 5 月期间，韩国首尔峨山医学中心儿童医院收治的年龄≤18 岁的单一致病菌血症患儿的临床资料，这些患儿为产 ESBL 的大肠埃希菌或肺炎克雷伯菌感染。评估经验性治疗的 30 天全因死亡率和 2 天微生物学结局（通过第 2 天经验性抗生素治疗后血培养无菌）。采用逻辑回归分析控制混杂因素的影响。
共纳入 53 例产 ESBL 的大肠埃希菌（n=29）和肺炎克雷伯菌（n=24）菌血症患儿，中位年龄为 3.6 岁，均有基础合并症。经验性抗生素治疗中，27 例使用美罗培南，26 例使用非碳青霉烯类药物；26 例中有 84.6%（22/26）在经验性抗生素治疗后第 2 天转换为碳青霉烯类抗生素作为确定性抗生素。总的来说，产 ESBL 的大肠埃希菌和肺炎克雷伯菌菌血症患儿的 30 天全因死亡率为 17.0%（9/53）。校正混杂因素后，使用非碳青霉烯类药物作为经验性抗生素与第 2 天和 30 天的全因死亡率无关[校正比值比（OR）1.0；95%置信区间（CI）0.22-4.88 和校正 OR 0.1；95% CI 0.01-1.56]。
如果能早期转换为适当的抗菌治疗，对于产 ESBL 的大肠埃希菌和肺炎克雷伯菌血流感染患儿，经验性使用非碳青霉烯类药物可能不是死亡率和早期微生物学结局的危险因素。
