Efficacy of non-carbapenem antibiotics for pediatric patients with first febrile urinary tract infection due to extended-spectrum beta-lactamase-producing Escherichia coli
Efficacy of non-carbapenem antibiotics for pediatric patients with first febrile urinary tract infection due to extended-spectrum beta-lactamase-producing Escherichia coli
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DOI：
10.1016/j.jiac.2017.04.006
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发表时间：
2017-08-01
影响因子：
2.2
通讯作者：
Itabashi, Kazuo
中科院分区：
文献类型：
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作者：
Abe, Yoshifusa;Inan-Erdogan, Isil;Itabashi, Kazuo
虽然碳青霉烯类药物被推荐用于治疗由产生超广谱 β-内酰胺酶 (ESBL) 的微生物引起的尿路感染 (UTI)，但据报道，非碳青霉烯类药物对于由产生 ESBL 的微生物引起的尿路感染成人患者有效。本研究的目的是根据微生物学和临床结果，评估非碳青霉烯类药物对产 ESBL 大肠杆菌 (E. coli) 引起的尿路感染儿科患者的疗效。本研究纳入了 15 名因产 ESBL 大肠杆菌引起的首次发热性尿路感染而接受治疗的儿童。抗菌药物敏感性和 ESBL 产量根据临床和实验室标准研究所指南确定。为了检测CTX-M基因，使用用于blaCTX-M检测的特异性引物进行聚合酶链反应。 15 例入组患者中，男孩 10 例（66.7%），女孩 5 例（33.3%），中位年龄为 4 个月。六名患者 (40%) 中检测到 VUR。对于通过PCR检测blaCTX-M，分别在5名、1名、8名和1名患者中检测到CTX-M-3、CTX-M-8、CTX-M-14和CTX-M-15。总体而言，15 个分离株中的 14 个（93.3%）对磷霉素（FOM）敏感，所有分离株对头孢美唑（CMZ）、氟氧头孢（FMOX）和亚胺培南/西司他丁（IPM/CS）敏感。在 15 名患者中，12 名（80%）在不使用碳青霉烯类药物的情况下临床症状得到改善。总之，即使根据 MIC 评估，产 ESBL 大肠杆菌分离株具有多重耐药性，但对非碳青霉烯类（例如 CMZ、FMOX 和 FOM）的临床敏感性也是可能的。因此，在临床实践中，可能并不总是需要碳青霉烯类药物来治疗儿童尿路感染。 (C) 2017 年日本化疗学会和日本传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Although carbapenem is the recommended for urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms, non-carbapenems have been reported to be effective for adult patients with UTI caused by ESBL-producing organisms. The purpose of this study was to evaluate the efficacy of non-carbapenems for pediatric patients with UTI due to ESBL-producing Escherichia coli (E. coli) based on the microbiologic and clinical outcomes. Fifteen children, who were treated for first febrile UTI caused by ESBL-producing E. coli were enrolled in this study. Antimicrobial susceptibilities and ESBL production were determined according to the Clinical and Laboratory Standards Institute guidelines. To detect CTX-M genes, polymerase chain reaction was performed with specific primers for blaCTX-M detection. Of the 15 enrolled patients, 10 (66.7%) were boys and 5 (33.3%) were girls, with a median age of four months. VUR was detected in six patients (40%). For detection of blaCTX-M by PCR, CTX-M-3, CTX-M-8, CTX-M-14, and CTX-M-15 were detected in five, one, eight, and one patient, respectively. Overall, 14 of the 15 isolates (93.3%) were susceptible for fosfomycin (FOM), and all isolates were susceptible for cefmetazole (CMZ), flomoxef (FMOX), and imipenem/cilastatin (IPM/CS). Of the 15 patients, 12 (80%) clinically improved without the use of carbapenems. In conclusion, even if isolates of ESBL-producing E. coli are multidrug resistant based on MIC assessment, clinical susceptibility to non-carbapenems, such as CMZ, FMOX, and FOM, is possible. Accordingly, carbapenems may not be required all the time for treatment of pediatric UTI in clinical practice. (C) 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.