2013 PIDJ ESBL Pyelonephritis

7/29/2019 2013 PIDJ ESBL Pyelonephritis

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The Pediatric Infectious Disease Journal Volume 32, Number 4, April 2013 Pyelonephritis With ESBLs

2013 Lippincott Williams & Wilkins www.pidj.com | 417

Abstract: y-u chldn w dagnd a ylnh caud by

xndd-cum -lacamaducngEnterobacteriaceae a h lag-

chldn hal n Jaan. Alhugh 32 (59%) an w ad

wh anmcbal ha a ncv agan h ganm, 39 (72%)

an bcam abl 2 day and clncal ucm wa xclln.

Chldn wh ylnh caud by xndd-cum -lacama

ducngEnterobacteriaceae can b uccully ad wh nncaba-

nm anmcbal.

Key Words: ylnh, xndd-cum -lacama, chld,

amn

Exndd-cum -lacama (esBL)-ducng Entero-bacteriaceae hav ad hughu h wld, and a gn-can nca n lad ncn and da ha bn bvdwldwd, ncludng n chldn.1 tamn n esBL-ducng Enterobacteriaceae a lmd bcau h bacaa an a numb cla anmcbal. Cabanma h amn chc u ncn caud by esBL-ducng Enterobacteriaceae;2,3 hwv, mcal cabanmamn ncn blvd b du esBL-ducngEnterobacteriaceae ha ubanally ncad bcau hnumb cabanm-an la.

rcnly, val hav dcud h clncal g-ncanc and amn ncn caud by esBL-ducng

Enterobacteriaceae.1,2 pylnh h m cmmn nc-n caud by h ganm; hwv, h a w daa n a-mn n and clncal ucm ylnh n chldn,cally h wh w ad wh nncabanm anmc-bal, whch hav bn ud wh cndabl clncal ucc a uch ncn n adul.2 th, w nvgad a-mn gmn and clncal ucm chldn wh w adwh nncabanm anmcbal ylnh caud byesBL-ducngEnterobacteriaceae.

METHODS

W cvly vwd h amn n and cln-cal ucm chldn wh dvld ylnh caud by

esBL-ducngEnterobacteriaceae. All chldn w an ah lag dac ay ca hal n Jaan, h NanalCn Chld Halh and Dvlmn n tky, bwn Al

Cygh 2013 by Lnc Wllam & WlknDoi: 10.1097/iN.0b013318284b18

TREATMENT OF PYELONEPHRITIS CAUSED

BY EXTENDED-SPECTRUM -LACTAMASE

PRODUCING ENTEROBACTERIACEAEIN CHILDREN

Tomohiro Katsuta, MD, PhD,* Kensuke Shoji, MD,Yasushi Watanabe, MS, and Akihiko Saitoh, MD, PhD

m h *Damn pdac, Dvn incu Da, s. Ma-anna Unvy schl Mdcn, Kanagawa; Damn Md-

cal scal, Dvn incu Da, Nanal Cn ChldHalh and Dvlmn; Damn Clncal labay, NanalCn Chld Halh and Dvlmn, tky; and Damn pd-ac, Ngaa Unvy Gadua schl Mdcal and Dnal scnc,Ngaa, Jaan.

pnd, n a, a h 5h Aan Cng pdac incu Da,ta, tawan, smb, 2010.

th udy wa ud by a Gan m h Nanal Cn Chld Halhand Dvlmn (21A-2 A.s.). th auh hav n h undng cn-fc n dcl.

Add cndnc: Akhk sah, MD, phD, AAp, 1757 Aah-mach, Chu-ku Ngaa, 9518510, Jaan. e-mal: [email protected].

2009 and Dcmb 2010. All un cmn w band bybladd cahzan ( yung chldn wh culd n unaby hmlv) by h mdam clan-cach mhd (wh-u h u a da chldn >3 ya). pylnh wadnd a h nc a v un culu (5 104 clnymng un/mL ahgn), yua (>5 wh bld cll/

hgh-w ld n cnugd cmn) and v (38C), nh abnc gn an alnav cau v. th halcu and clncal ucm h chldn w mnd 4 wk a h d. W xcludd an wh bacma.Amn anmcbal ucbl and dncan esBL ganm w dn accdng h 2009 Clncal andLabay sandad inu gudln.4

th llwng nman wa xacd m h mdcalcd daaba: ag, x, baln da, vu hy unay ac ncn (Uti) and cauav ganm, anmcb-al Uti hylax, vu unay culu ul, duan v, anmcbal hay (mcal and dnv hay)and duan and clncal ucm (lun v [37C],ncn la whn 4 wk a cmln hay).

pan ucm wa clad ung ablhd dnn: cuwa dnd a abnc ymm and n cunc h amla, and la wa dnd a cunc ymm ncmbnan wh lan h am ganm.

W ud h spss 15.0 wa ackag (spss, inc., Ch-cag, iL) h analy. th ch-qua and h xac w ud cma cagcal vaabl bwn 2 gu.th MannWhny U and KukalWall w ud cma cnnuu vaabl bwn 2 gu and amng 3 m gu, cvly. AllPvalu w 2-ald and w cn-dd gncan P< 0.05.

RESULTS

Patient Characteristics

Dung h bvan d, 55 an cvd a dag-n ylnh caud by esBL-ducng Enterobacte-riaceae; 1 an wh bacma wa xcludd m h udy.Mdan ag h udy ulan wa 28 mnh (nqualang: 92 mnh), and 38 h 54 (70%) an w mal.rgadng a mdcal hy lad Uti, ylnh wand n 38 (70%), anamc anmal n 20 (37%), nugncbladd dyuncn n 18 (33%) and vcual fux n 14(26%). twny (37%) chldn w mmuncmmd, whchwa dnd a nc nuna mmunuanamn, dnn (2 mg/kg day >14 day), cycl-n, aclmu hyda h chmhauc agn

dung h a 3 mnh.

Treatments

Man duan hay wa 13.7 day (ang: 724 day).Man duan mcal and dnv hay w 4.5 day(ang: 211) and 9.2 day (ang: 221), cvly. tabl 1 hwh dal h amn gmn. inally, 32 (59%) chldnw ad wh anmcbal ha a ncv agan esBL-ducng ganm. A dncan esBL-ducngla, 52 chldn (96%) w wchd anmcbal ha acv agan uch la, and nly 2 (4%) chldn cnnudamn wh h am anmcbal.

Clinical Outcomes

M an (72%) bcam abl whn 2 day (av-ag: 2.1 day; ang: 15 day). Duan v a nanganmcbal amn dd n d by x (P= 0.33), a hy
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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Katsuta et al The Pediatric Infectious Disease Journal Volume 32, Number 4, April 2013

418 | www.pidj.com 2013 Lippincott Williams & Wilkins

ylnh (P= 0.44) hylacc amn wh

ulamhxazl/mhm (P= 0.27) cacl (P= 0.71).Amng 32 an ad wh anmcbal ha w an h la, 24 (75%) bcam abl b h anmcb-al w wchd aa anmcbal. th man dua-n anmcbal hay ha w an h la wa4.4 day. in addn, duan v a nang anmc-bal amn dd n d bwn h wh cvd uc-bl agn and h wh cvd nnucbl anmcbal(2.0 day vu 2.2 day, cvly;P= 0.62). Hwv, mmu-ncmmd an had a lng duan v a n-an hay han dd mmuncmn an (2.5 dayvu 1.9 day; P= 0.01). All an cud ncn and nla wa bvd.

DISCUSSION

t u knwldg, h udy nlld h lag numb chldn ad wh nncabanm anmcbal yl-nh caud by esBL-ducng Enterobacteriaceae whubacma. tamn wh nncabanm anmcbal wauccul, and h wa n ca amn alu dung hbvan d.

sm vdnc ndca ha cabanm a h dug chc ncn caud by esBL-ducng Enterobac-teriaceae.2 inaa anmcbal chc mgh hav a dl-u mac nncabanm anmcbal a lcd an wh u ncn uch a bacma.5 h

an, anmcbal mu b caully lcd n uly llan wh ucd bacma caud by esBL-ducngEnterobacteriaceae. Nvhl, hycan huld avd vu

cabanm, a culd lad dvlmn and wnng ncn and da caud by cabanm-an la.thu, knwldg h k ac ncn caud by esBL-ducng ganm n chldn culd ad n dnyng hgh-kan and nabl nan aa mcal hay uch an. th k ac nclud mal x, ncn wh

Klebsiella , d u, xu xndd-cum cha-ln whn h vu 30 day, undlyng da, hal-zan whn h vu 3 mnh and hy v culu esBL-ducng ganm.68 i any h k ac an, and an a blvd b uly ll, cabanmman h b amn n.

t nu aa anmcbal u, nncabanmamn n huld b cndd ncn caudby esBL-ducng ganm. th chamycn (g, cma-zl) a abl agan h hydlyc c esBL, and v-al ud und ha hy a cv ang ncncaud by esBL-ducng ganm.2 in u udy, hgh -n la esBL-ducng Escherichia coli (97%) andKlebsiella pneumoniae (85%) w ucbl cmazl.

Cmazl wa ud a a -ln hay n 11 an, andclncal ucm w xclln. Bcau chamycn hav anaw cum and a l xnv han cabanm, hyculd b an xclln alnav chldn whu bacmawh hav ylnh caud by esBL-ducng Enterobac-teriaceae.

thd-gnan chaln a h m cmmnanmcbal ud ang Uti, bu ucbly hw ha esBL-ducng ganm a an dug nh cla. Hwv, bcau h hgh unay cncnan,hy hav bn uccully ud a ylnh caud byesBL-ducng ganm.9 in h cun udy, m chldncvd hd-gnan chaln a mcal hay anddd wll dung h amn d. oh anmcbal ha a

nally cv n ang ylnh caud by esBL-ducng ganm a -lacam cmbnd wh -lacamanhb, amnglycd, fuqunln and mycn.2,10Ununaly, h a w clncal daa n h cvn h agn agan esBL-ducng la. Addnal clncaldaa n h u h agn n chldn a ndd.

th cun udy ha m lman. , du hudy dgn, h udy ulan wa dawn m a ngl d-ac hal n Jaan and wa mall. scnd, h wa a c-v udy ha lackd a cnl gu, and chc anmcbalwa manly a h dcn ndvdual hycan; h,chc and chang anmcbal w n cnlld. thd, allw-u un culu wa n band n all an; hu, hly un culu wa n cnmd. nally, h cndayucm h cun udy wa dmnd n h ba md-cal cd, whch may hav lackd lvan nman.

in cnclun, nncabanm anmcbal amn ylnh caud by esBL-ducngEnterobacteriaceae wauccul n chldn. A uh cv udy waand nd cnm ha h amn cv ang yln-h caud by esBL-ducngEnterobacteriaceae n chldn.

REFERENCES

1. Blachk AJ, Kgnk eK, Daly JA, al. exndd-cum ba-laca-ma-ducng ahgn n a chldn hal: a 5-ya xnc.AmJ Inect Control. 2009;37:435441.

2. pan DL, Bnm rA. exndd-cum ba-lacama: a clncaluda. Clin Microbiol Rev. 2005;18:657686.

3. pan DL, K WC, Vn Gbg A, al. Anbc hay Klb-lla numna bacma: mlcan ducn xndd-cum ba-lacama. Clin Inect Dis. 2004;39:3137.

TABLE 1. Details o Treatments Received by Study

Subjects

Antibiotics

Empirical Therapy*Denitive

Therapy

Susceptible Intermediate orResistant

ParenteralCemetazole 10 1 21

Ceazolin 0 1 0

Ceotiam 0 2 0

Cetazidime 0 1 0

Ceotaxime 0 14 0

Ceepime 0 8 0

Ampicillin/sulbactam 0 1 1

Piperacillin/azobactam 5 1 3

Gentamicin 0 1 3

Ciprofoxacin 0 0 2

Meropenem 7 0 2

Oral

Ceaclor 0 1 0

Sulamethoxazole/trimethoprim

0 0 13 (+3)

Fosomycin 0 0 6 (+1)

Ciprofoxacin 0 1 2 (+2)

Levofoxacin 0 0 1

Total 22 32 54 (+6)

*All o 54 patients, 16 (30%) were introduced antimicrobial prophylaxis beore the

empiric therapy with sulamethoxazole/trimethoprim: 10 (19%) and ceaclor: 6 (11%).Isolated organisms were Escherichia coli : 33 (61%), Klebsiella pneumoniae: 20

(37%) and Citrobacter freundii: 1 (2%).Two patients received the same antibiotics or empirical and denitive therapy,

namely, cemetazole (n = 1; 2%) and ampicillin/sulbactam (n = 1; 2%).Six patients were switched to denitive oral therapy rom denitive parenteral

therapy (+X).


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The Pediatric Infectious Disease Journal Volume 32, Number 4, April 2013 Pleural Effusions in Taiwanese Children

2013 Lippincott Williams & Wilkins www.pidj.com | 419

4. Clncal and Labay sandad inu. 2009 Perormance Standardsor Antimicrobial Susceptibility Testing: Nineteenth Inormation Supplement(M100-S19). Wayn, pA: Clncal and Labay sandad inu; 2009.

5. Launbach e, pal JB, Blk WB, al. exndd-cum ba-lacama-ducng echcha cl and Klblla numna: k ac- ncn and mac anc n ucm. Clin Inect Dis.2001;32:11621171.

6. Zau te, Gyal M, Chu JH, al. rk ac and ucm bldam ncn caud by xndd-cum ba-lacama-ducng echcha cl and Klblla c n chldn. Pediatrics.2005;115:942949.

7. Ku KC, shn YH, Hwang Kp. Clncal mlcan and k ac xndd-cum ba-lacama-ducng Klblla num-na ncn n chldn: a ca-cnl cv udy n a md-cal cn n uhn tawan. J Microbiol Immunol Inect. 2007;40:248254.

8. talglu r, e i, Dgan BG, al. rk ac n cmmuny-acqudunay ac ncn caud by esBL-ducng baca n chldn.Pediatr Nephrol. 2010;25:919925.

9. tala A, id e, ianndu M, al. oucm unay ac nc-n caud by xndd cum -lacama-ducng enbac-aca n chldn.Pediatr Inect Dis J. 2011;30:707710.

10. alaga Me, Ka AC, Kaakl AM, al. mycn h a-

mn muldug-an, ncludng xndd-cum ba-lacamaducng, enbacaca ncn: a ymac vw.Lancet InectDis. 2010;10:4350.

Abstract: W analyzd bld and lual fud aml m 89 tawan

chldn wh myma hac and aanumnc lual un. Strep-

tococcus pneumoniaewa h maj ahgn, dnd n 12 chldn by bac-

al culu and 53 chldn by mlcula chnqu, and y 19A wa

h dmnan y. Al nwhy wa h dcn numcccal

y 1,Haemophilus infuenzae andMycoplasma pneumoniae n h

chldn.

Key Words: myma hac, lual un, mlcula chnqu,

bacal culu, tawan

Accd ublcan Januay 4, 2013.m h *Chang Gung Mmal Hal, Chang Gung Unvy Cllg

Mdcn, tayuan; Chna Mdcal Unvy schl Mdcn, ChnaMdcal Unvy Hal, tachung; Nanal Chng Kung UnvyHal, Cllg Mdcn, Nanal Chng Kung Unvy, tanan;ta Van Gnal Hal, ta, tawan; Cn incuDa and Mcblgy, Wmad Hal, Unvy sydny, Nwsuh Wal, Auala; GlaxsmhKln Vaccn, rxna, Blgum;**GlaxsmhKln Vaccn, tua, snga (m alan); andNanal tawan Unvy Hal, ta, tawan.

Jav sawchk Mngal, phD cunly a h dal Agncy Mdcnand Halh pduc, Bul, Blgum.

t-Y. L. and K.p.H. cnbud qually h wk.GlaxsmhKln Blgcal sA (rxna, Blgum) wa h undng uc

and wa nvlvd n all ag h udy cnduc and analy. Glaxs-mhKln Blgcal sA al undd all c acad wh h dvl-mn and h ublhng h n manuc. All auh cnbud h udy, w nvlvd n wng and vwng h a and avd hnal vn. All auh had ull acc h daa and h cndngauh had nal nbly ubmn h manuc. t-Y.L. ha

ETIOLOGY OF EMPYEMA THORACIS AND

PARAPNEUMONIC PLEURAL EFFUSION IN

TAIWANESE CHILDREN AND ADOLESCENTS

YOUNGER THAN 18 YEARS OF AGE

Tzou-Yien Lin, MD,* Kao Pin Hwang, MD, PhD,Ching-Chuan Liu, MD, MPH, Ren Bin Tang, MD,Ching Yuang Lin, MD, Gwendolyn L. Gilbert, MD,Kiran Thapa, MSc, Javier Sawchik Monegal, PhD,

Jean-Yves Piron, PhD, Melissa K. Van Dyke, PhD,Yan Fang Liu, MD,** Li-Min Huang, PhD, andWilliam P. Hausdor, PhD

Cygh 2013 by Lnc Wllam & WlknDoi: 10.1097/iN.0b01331828637b1

cvd nunal gan h n wk and aymn dvl-mn ducanal nan m h GlaxsmhKln gu cm-an; K.p.H. dcla n cnfc n; C-C.L. dcla n cnfc n; r.B.t. dcla n cnfc n; C.Y.L. ha cvd undngm h GlaxsmhKln gu cman ach n whch hn acl bad; G.L.G. ha cvd gan m h Glaxsmh-Kln gu cman manc labay h njc a wll a a mla jc n Auala; K.t. dcla n cnfc

n; J.s.M. wa an mly h GlaxsmhKln gu cm-an; J-Y.p. an mly h GlaxsmhKln gu cman;M.K.V.D. an mly h GlaxsmhKln gu cman anddcla ck wnh; Y..L. wa an mly h GlaxsmhKlngu cman and had ck wnh; L-M.H. ha cvd nu-nal gan h n wk m h Nanal tawan Unvy H-al (ta, tawan). H al cvd m h GlaxsmhKln gu cman acan n advy bad n a HpV vaccn jc, cnulancy (clncal al cl) and gvng lcu n vaccn.H ha cvd nunal gan m h GlaxsmhKln gu cman dcn ganm n emyma; W.p.H. an mly h GlaxsmhKln gu cman and dcla ck wnh. H chld h an pvna 13 (Wyh, Nw Yk, NY). th auhhav n h undng cnfc n dcl.

Add cndnc: L-Mn Huang, phD, Damn pdac,Nanal tawan Unvy Hal, 7 Chung-shan suh rad, ta, ta-wan 100. e-mal: [email protected].

Bacal numna may ul n aanumnc lual u-n (ppe) myma hac (et), 2 cndn ha cancau gncan mbdy. Bwn 1997 and 2004, h ula-n-bad annual et ncdnc wa mad a 10.5 d 100,000 chldn wh w yung han 5 ya ag n tawanand, a lwh, aad b ncang.1

pvu analy lual fud (p) aml by bac-al culu uggd Streptococcus pneumoniae (Spn) a hdmnan lgc agn n tawan chldn,2 wh h majgu bng 14, 23, 6 and 19.3 Hwv, m aml w

culu ngav, lkly a ul anbc amn, and habn bvd lwh ha mlcula chnqu can uncv abad ang ahgn and y.46 th udy ud ly-ma chan acn (pCr)-bad chnqu b chaac-z h lgy et and ppe n tawan chldn.

MATERIALS AND METHODS

th bvanal, cv, hal-bad uvllancudy wa cnducd n 6 cn n tawan bwn Al 2008 andocb 2009 accdng Gd Clncal pacc gudln andh Dclaan Hlnk. B nllmn, nmd cnnwa band m h an/guadan ach acan andnmd an m ach chld agd m han 7 ya. th -

cl and cnn m w avd by lcal hc cmm.th udy agd nllmn ~100 chldn yung

han 18 ya ag, admd udy hal wh et ppe,wh clncal cndn ncad a dagnc haccn a hacmy p danag and wh p aml wa aval-abl labay ng. Maj xclun ca ncludd a-can n anh clncal udy knwn malgnancy, cllagnvacula da mld.

ach nlld chld, dmgahc chaacc, gnalgn and ymm, mdcal hy, bchmcal cmn p and bld aml, amn gvn, duan halzanand ucm a dchag w cdd. A lcal hal laba-, p and bld aml w culud aculav bac-a (g. 1).7 th maccc nc u n p aml wa

akn dny chldn wh et. A acn h p amlal undwn andad bacal culu and mlcula analya h Cn incu Da and Mcblgy (Nw suh
mailto:[email protected]:[email protected]

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2013 PIDJ ESBL Pyelonephritis