Empirical antibiotics of non-carbapenems for ESBL-producing E. coli and K. pneumoniae bacteremia in children : a retrospective medical record review

Background: The efficacy of non-carbapenems as an empirical antibiotic for extended-spectrum β-lactamases (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia in children remains controversial. We compared clinical and microbial outcomes according to the types of empirical antibiotics for treating pediatric patients with ESBL-producing E. coli and K. pneumoniae bacteremia. Methods: Data from pediatric patients aged ≤18 years who were hospitalized with monomicrobial ESBL-producing E. coli or K. pneumoniae bacteremia between January 2014 and May 2019 were analyzed retrospectively. The impact of empirical therapy was assessed as 30-day all-cause mortality and 2-day microbiological outcomes evaluated by sterility of blood cultures collected on day 2 after empirical antibiotic administration. Logistic regression analysis was used to control for the effects of confounding variables. Results: A total of 53 patients with bacteremia caused by ESBL-producing E. coli (n=29) and K. pneumoniae (n=24) were included in this study; the median age was 3.6 years, and all had underlying comorbidities. As empirical antibiotics, 27 patients were treated with meropenem, and non-carbapenem agents were administered to 26 patients; 84.6% (22/26) were converted to carbapenem antibiotics as the definitive antibiotic by day 2 after empirical antibiotic administration. Overall, the 30-day all-cause mortality of ESBL-producing E. coli and K. pneumoniae bacteremia was 17.0% (9/53). After adjustment, there was no statistically significant association of use of a non-carbapenem agent as an empirical antibiotic with microbiological failure at day 2 and 30-day all-cause mortality [adjusted odds ratio (OR), 1.0; 95% confidence interval (CI), 0.22–4.88, and adjusted OR, 0.1; 95% Cl, 0.01–1.56]. Conclusions: The empirical use of non-carbapenems might not be a risk factor for mortality and early microbiological outcomes in pediatric patients with ESBL-producing E. coli and K. pneumoniae BSI if early transition to appropriate antimicrobial therapy was possible.