• Med Mal Infect · May 2018

    Multicenter Study Observational Study

    Extended-spectrum β-lactamase-producing Enterobacteriaceae, national study of antimicrobial treatment for pediatric urinary tract infection.

    • M Lagree, S Bontemps, R Dessein, F Angoulvant, F Madhi, A Martinot, R Cohen, F Dubos, and GPIP.
    • Urgences pédiatriques et maladies infectieuses, université de Lille, centre hospitalier régional universitaire (CHRU de Lille), 59000 Lille, France; Groupe de pathologie infectieuse pédiatrique (Paediatric Infectious Disease Group), France.
    • Med Mal Infect. 2018 May 1; 48 (3): 193-201.

    ObjectiveTo evaluate clinical practices for ESBL-producing urinary tract infection (UTI) in France.MethodsWe performed an observational, retrospective, cross-sectional, hospital-based study in 22 pediatric departments of university or secondary care hospitals. We collected data of the last five patients presenting with ESBL-producing UTI in 2012 and the physicians' therapeutic approach to two case vignettes of acute non-septic ESBL-producing pyelonephritis (7-month-old girl) and cystitis (30-month-old girl). The adequacy of the therapeutic decision was analyzed by a panel of independent infectious disease experts.ResultsA total of 80 case patients of ESBL-producing UTI were collected: 54 with acute pyelonephritis (mean age: 28 months, female: 66%), of whom 98% received an intravenous ESBL-adapted antibiotic treatment and 55% a two-drug antibiotic therapy. Carbapenems were used in 56% of cases and aminoglycosides in 36%. Of the 26 cystitis patients (mean age: 5 years, female: 73%), 85% were treated with antibiotics, including three intravenously (carbapenems=2). For the case vignettes, physicians (n=85) would have treated the pyelonephritis patient with carbapenems (76%) and/or aminoglycosides (68%); 71% would have used a two-drug antibiotic treatment. The cystitis patient would have been treated intravenously by 29% of physicians; 8% would have used a two-drug antibiotic treatment, 16% would have prescribed carbapenems, and 11% aminoglycosides. Antibiotic treatments were deemed appropriate in 37% of cases.ConclusionsAntimicrobial treatment for ESBL-producing UTI greatly varies, and carbapenems are excessively prescribed. Specific guidelines for ESBL infections are required.Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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