scholarly journals Relay oral therapy in febrile urinary tract infections caused by extended spectrum beta-lactamase–producing Enterobacteriaceae in children: A French multicenter study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257217
Author(s):  
Gabriel Lignieres ◽  
André Birgy ◽  
Camille Jung ◽  
Stéphane Bonacorsi ◽  
Corinne Levy ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Drug Testing ◽  
Therapeutic Option ◽  
Multicentric Study ◽  
Extended Spectrum Beta Lactamase ◽  
End Of Treatment ◽  
Amoxicillin Clavulanate ◽  
Febrile Urinary Tract Infections ◽  
Tract Infections

Objectives We need studies assessing therapeutic options for oral relay in febrile urinary tract infection (FUTI) due to ESBL–producing Enterobacteriaceae (ESBL-E) in children. Amoxicillin-clavulanate/cefixime (AC-cefixime) combination seems to be a suitable option. We sought to describe the risk of recurrence at 1 month after the end of treatment for FUTI due to ESBL-E according to the oral relay therapy used. Materials and methods We retrospectively identified children <18 years who were included in a previous prospective observational multicentric study on managing FUTI due to ESBL-E between 2014 and 2017 in France. We collected whether children who received cotrimoxazole, ciprofloxacin or the AC-cefixime combination as the oral relay therapy reported a recurrence within the first month after the end of treatment. Then, we analyzed the susceptibility drug-testing of the strains involved. Results We included 199 children who received an oral relay therapy with cotrimoxazole (n = 72, 36.2%), ciprofloxacin (n = 38, 19.1%) or the AC-cefixime combination (n = 89, 44.7%). Nine (4.5%) patients had a recurrence within the first month after the end of treatment, with no difference between the 3 groups of oral relay (p = 0.8): 4 (5.6%) cotrimoxazole, 2 (5.3%) ciprofloxacin and 3 (3.4%) AC-cefixime combination. Phenotype characterization of 249 strains responsible for FUTI due to ESBL-E showed that 97.6% were susceptible to the AC-cefixime combination. Conclusions The AC-cefixime combination represents an interesting therapeutic option for oral relay treatment of FUTI due to ESBL-E as the recurrence rate at 1 month after the end of treatment was the same when compared to cotrimoxazole and ciprofloxacin.

scholarly journals 477. Characterization of Extended-Spectrum Β-Lactamase (ESBL) Producing Gram-negative (GN) Urinary Tract Infections (UTI) in Pediatric Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S233-S233
Author(s):  
Leslie Stach ◽  
Regina Orbach ◽  
Kanokporn Mongkolrattanothai
Keyword(s):  
Urinary Tract ◽  
Pediatric Patients ◽  
Selective Pressure ◽  
Once Daily ◽  
E Coli ◽  
Colony Forming Units ◽  
Amoxicillin Clavulanate ◽  
Tract Infections ◽  
Abnormal Urinary Tract

Abstract Background There has been an increase in antimicrobial resistance among GN pathogens, not only in adults, but also pediatrics. UTIs are common in pediatrics; however, reports of pediatric UTI with ESBL producing GN are limited. Methods All urine cultures positive for ESBL producing GN from 5/1/18 to December 31/18 were retrospectively reviewed. Proven infection (PI) defined as ≥50,000 colony-forming units (CFU)/mL of bacteria plus pyuria or positive leukocyte esterase for catheterized or clean catch specimens. Relapsed infection defined as same pathogen cultured within 30 days of infection. Abnormal urinary tract systems or functions (AUTS) include neurogenic bladder, structural anomalies, or intermittent catheterization. Results A total of 107 urine cultures for ESBL producing GN, from 85 patients, were included. Majority of specimens [78/107 (73%)] were obtained from the ED or outpatient clinics. 43% of specimens were from patients with AUTS. E. coli was the majority (95%) of ESBL isolates. 57% of ESBL producing GNs were susceptible to amoxicillin/clavulanate (AC) or trimethoprim/sulfamethoxazole (TMP/SMX). 88% were nitrofurantoin susceptible. Only 1 isolate was meropenem resistant. Antibiotics (ABX) were prescribed for UTI in 67/107 episodes. However, only 52 episodes were PI. Of these, 38 were empirically treated with oral ABX and 29 with intravenous ABX. The most commonly prescribed empiric ABX was oral cephalexin (25/67, 37%.) Ineffective empiric ABX for UTI was very common, 83% (43/52). Of these, 5/43 never received effective therapy and none had relapse. Most common duration of ABX was 10 days (range 5–17 days.) 43% (23/52) of PI were treated with oral AC or TMP/SMX. 15% (8/52) of PI were treated with nitrofurantoin. 12% of PI were treated with a once-daily aminoglycoside. Only 6% of PI were treated with a carbapenem. Conclusion Many ESBL UTI isolates remain susceptible to oral ABX. Although small numbers, patients treated with ineffective ABX did not return with relapsed infection. Non-carbapenem ABX are a reasonable option to minimize selective pressure or unnecessary use. Empiric narrow-spectrum antibiotic therapy may still be appropriate. Disclosures All authors: No reported disclosures.

Molecular Characterization of Extended Spectrum Beta – Lactamase Producing Escherichia Coli Isolated from Pregnant Women with Urinary Tract Infections Attending Ante–Natal Clinics in Ilorin Metropolis

2021 ◽  
Vol 17 (1) ◽  
pp. 119-129
Author(s):  
R.H. Bello ◽  
Y.K.E. Ibrahim ◽  
B.O. Olayinka ◽  
A.A.G. Jimoh ◽  
N.B. Afolabi-Balogun ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Pregnant Women ◽  
Urinary Tract Infections ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum ◽  
Bacteriological Method ◽  
Antibiotics Susceptibility ◽  
Tract Infections ◽  
In Pregnancy

Background: The emergence of multidrug- resistance Enterobacteriaceae especially in E. coli bacteria  associated with Urinary Tract Infections (UTIs) in pregnancy is a serious menace globally posing health challenges and confounding successful empirical treatment as well as increasing pregnancy – related  complications.Objectives: The aim of this study is to determine the phenotypic and genotypic characteristics of Extended Spectrum Beta – Lactamases (ESBLs) producing E. coli (ESBLs – EC) isolates in pregnant women attending ante – natal clinics within Ilorin - Kwara State, Nigeria.Materials and methods: A total of 53 non - repeated E. coli isolates from urine samples of pregnant women were presumptively identified using standard bacteriological method and confirmed by commercially available Microgen® Identification Kits. Phenotypic detection of ESBLs was determined using antibiotics susceptibility test and double disc synergy Method for screening and confirmation respectively. Polymerase Chain Reaction (PCR) was further used for the genotypic detection of ESBLs genes.Results: A total 88.67% (47/53) of E. coli exhibited resistance to the cephalosporins of which aztreonam was the highest (75.47%) and the least was cefpodoxime (35.84%) while 85.10% were confirmed positive for ESBL production. The genotypic detection showed the most occurring genotype was blaTEM (50%) blaOXA (27.7%), blaGES (22.5%), blaSHV (15%), blaCTXM and blaVEB (7.5%) while sixty – four (64%) of isolates co – harbored two or more gene. BlaTEM and blaOXA were dominant.Conclusion: This study showed high resistance of E. coli to the third generation cephalosporins harboring different ESBL genes which increases UTIs complexity and limit therapeutic options in pregnancy. Therefore, continuous monitoring of resistance in E. coli, effective appraisal of antibiotic control policies and rational use of antibiotics is therefore encouraged.

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