Treatment and Outcomes of Children With Febrile Urinary Tract Infection Due to Extended Spectrum Beta-lactamase-producing Bacteria in Europe: TOO CUTE Study.

BACKGROUND: The prevalence of extended-spectrum beta-lactamase producing Εnterobacteriaceae (ESBL-PE) is increasing globally. ESBL-PE are an important cause of urinary tract infections (UTIs) in children. We aimed to characterize the clinical presentation, treatment and outcomes of childhood UTI caused by ESBL-PE in Europe. METHODS: Multicenter retrospective cohort study. Children 0 to 18 years of age with fever, positive urinalysis and positive urine culture for an ESBL-PE uropathogen, seen in a participating hospital from January 2016 to July 2017, were included. MAIN OUTCOME MEASURES: Primary outcome measure: day of defervescence was compared between (1) initial microbiologically effective treatment (IET) versus initial microbiologically ineffective treatment (IIT) and (2) single initial antibiotic treatment versus combined initial antibiotic treatment. SECONDARY OUTCOME MEASURES: Clinical and microbiologic failure of initial treatment. RESULTS: We included 142 children from 14 hospitals in 8 countries. Sixty-one children had IET and 77 IIT. There was no statistical difference in time to defervescence for effective/ineffective groups (P = 0.722) and single/combination therapy groups (P = 0.574). Two of 59 (3.4%) and 4/66 (6.1%) patients exhibited clinical failure during treatment (P = 0.683) when receiving IET or IIT, respectively. Eight of 51 (15.7%) receiving IET and 6/58 (10.3%) receiving IIT patients (P = 0.568) had recurring symptoms/signs suggestive of a UTI. Recurrence of a UTI occurred 15.5 days (interquartile range, 9.0-19.0) after the end of treatment. CONCLUSIONS: Time to defervescence and clinical failure did not differ between IET/IIT groups. Non-carbapenem beta-lactam antibiotics may be used for the empiric treatment of ESBL febrile UTIs, until susceptibility testing results become available.

Risk factors for colonization with ampicillin and high-level aminoglycoside-resistant enterococci during hospitalization in the ICU and the impact of prior antimicrobial exposure definition: a prospective cohort study.

The aim of our prospective cohort study was to determine the incidence, genetic relatedness and risk factors for colonization with ampicillin and high-level aminoglycoside-resistant enterococci (ARHLARE) among patients hospitalized in the intensive care unit. During 15-month period, we included 105 patients. The only independent risk factor for ARHLARE colonization was days of cefotaxime/ceftriaxone therapy [odds ratio (OR): 1.13; 95% confidence interval (CI) 1.10-1.27; P  =  0.045]. Patients with higher total use of antibiotics, patients on prolonged mechanical ventilation, and patients with urinary tract infection (UTI), were also found to be at increased risk to become colonized with ARHLARE. Pulsed-field gel electrophoresis suggested multifocal origin of the majority of the colonizing strains. Our results show that an increase in total antibiotic consumption for 10 defined daily doses (DDD)/patient increased the odds of colonization with ARHLARE for 36%. Further efforts to optimize antimicrobial use in high risk patients are proposed.