Abstract
Background
The clinical efficacy of non-carbapenem for the treatment of extended-spectrum β-lactamase (ESBL) bacteremia in children with underlying comorbidities is controversial. We aimed to compare clinical and microbiological outcomes between pediatric patients received carbapenem and non-carbapenem as empiric regimens for bacteremia caused by ESBL producing E. coli and K. pneumoniae.
Methods
Pediatric patients aged <19 years who hospitalized between January 2014 to Jun. 2018 at Asan medical center with monomicrobial ESBL producing E. coli and K. pneumoniae bacteremia were included. Patients were excluded if they did not receive a carbapenem after ESBL production was identified. We compared outcomes between patients who had empirical therapy with a carbapenem to those who had empirical therapy with a non-carbapenem.
Results
Among total 161 E. coli and K. pneumoniae bacteremia, 46 (28.6%) fulfilled the criteria, of which 25 (54.3%) were caused by E. coli and 21 (45.7%) by K. pneumoniae. The most common underlying diseases were hemato-oncologic diseases (47.8%) and prematurity (23.9%). The main sources of bacteremia were vascular catheter (37.0%) and necrotizing enterocolitis (10.9%). 25 cases were treated with empiric carbapenem, and the remaining 21 cases with non-carbapenem agents. The all-cause 30-day fatality in the carbapenem group was 32% (8/25) and 5% (1/21) in the non-carbapenem group (P = 0.023). Microbiological cure rate at 3 days after the first culture positive day was 75.3% in the carbapenem group and 89.6% in the non-carbapenem group (P = 0.046). However, adjusting initial presentation with septic shock, the choice of initial empiric antibiotic was not a risk factor for the 30-day fatality and microbiological cure rate at 3 days (aHR 4.82, 95% CI 0.592–39.231; aHR 0.648, 95% CI 0.333- 1.259, respectively).
Conclusion
For the medically fragile pediatric patients with bacteremia caused by ESBL producing E. coli and K. pneumoniae, the impact of empiric antibiotics on clinical and microbiological outcomes was not significant if early transition to definitive carbapenem regimen is possible when susceptibility is proven. A large-scale multicenter study will be needed to select the most appropriate empiric antibiotics and minimize the spread of antibiotics resistance.
Disclosures
All authors: No reported disclosures.
Session: 159. Pediatric Bacterial Diseases: Diagnosis and Management
Friday, October 4, 2019: 12:15 PM