Controversies in treating febrile infantile urinary tract infection caused by extended-spectrum beta-lactamase producing Enterobacteriaceae: an international multi-centre survey.

Abstract

Background: There is a lack of consensus in treating infants with extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) urinary tract infection (UTI) who demonstrate good clinical response to initial antibiotics within 48 h.

Methods: We conducted an international survey among paediatric nephrologists and fellows in training using a web-based questionnaire.

Results: A total of 232 centres across 77 countries participated in the survey. Second- or third-generation cephalosporins were the initial antibiotic of choice upon presentation in 63.8% of the centres. If the ESBL-E isolated from urine culture demonstrated in vitro susceptibility, 81.0% of respondents would continue the initial oral antibiotics. In contrast, there was considerable practice variation in the presence of in vitro resistance to the initial oral antibiotic. 19.0% would switch to a carbapenem group antibiotic, while 49.6% would change to a non-carbapenem antibiotic according to the sensitivity profiles. 22.8% would continue initial antibiotics based on satisfactory clinical response. The remaining 8.6% would choose other options. Similar emphasis on in vitro susceptibility result for the treatment was observed among centres who treated patients with intravenous antibiotics at UTI presentation. In the presence of a UTI with an ESBL-E, 50.0% centres would perform additional radiological investigations, and 61.2% would offer antibiotic prophylaxis to prevent further UTIs.

Conclusion: There are significant variations in the management of UTI caused by ESBL-E bacteria between centres. In vitro susceptibility to the antibiotics remains an important management consideration. Antibiotics from the non-carbapenem groups seem to be the preferred option. Further studies are required to identify the optimal treatment regimen in this patient population.