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Amikacin, imipenem, ertapenem inhibited most intra-abdominal infections in pediatric ICU
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Amikacin, imipenem and ertapenem were the most effective antimicrobials against gram-negative bacteria from pediatric intra-abdominal infections, followed by the fluoroquinolones and cefepime, according to recent study results.
In recent years, the spread of extended-spectrum beta-lactamases (ESBLs) — more concentrated in ICUs than in other facilities — has affected antimicrobial efficacy and usage.
The Study for Monitoring Antimicrobial Resistance Trends has maintained surveillance on the in vitro activity of ertapenem and several comparators against aerobic gram-negative bacteria from intra-abdominal infections for many years.
To determine susceptibility levels and epidemiology for pivotal intra-abdominal infections pathogens cultured from general pediatric medical wards and pediatric ICUs globally, the researchers collected 1,248 gram-negative bacteria from pediatric intra-abdominal infections by 113 labs in 40 countries from 2008 to 2010.
Susceptibility was assessed by Clinical and Laboratory Standards Institute broth microdilution, whereas susceptibility rates were calculated for species with at least 10 isolates.
The researchers found that 62% of isolates came from general pediatric wards, whereas 38% were derived from pediatric ICUs.
The general ESBL-positive rate was 11% for Escherichia coli, and 38.9% for Klebsiella pneumoniae; the ESBL-positive rate for E. coli was twice as high in the ICU as non-ICU.
Although most of the drugs in the study inhibited more than 90% of ESBL-negative isolates, only the carbapenems inhibited more than 90% of ESBL-positive E. coli, and only imipenem inhibited more than 90% of ESBL-positive K. pneumoniae.
According to researchers, therapy for pediatric intra-abdominal infections should reflect local ESBL rates because only carbapenems inhibited most of these pathogens.
Disclosure: The researchers reported funding and employment relationships with IHMA Inc. and Merck.
Perspective
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Samir S. Shah, MD, MSCE
Antibiotic-resistant bacteria are an emerging threat to human health. These resistant bacteria pose serious health risks because they are resistant to virtually all antibiotics. These bacteria may transfer that resistance to other bacteria, exponentially worsening an already serious problem. While these resistant bacteria were once limited to persons requiring frequent or prolonged hospitalizations, they have now spread to the community. When these bacteria cause infection, as in the case of a ruptured appendix, the infection can be difficult to treat, leading to longer hospital stays and, sometimes, death.
Badal and colleagues collected more than 1,000 bacterial samples from patients with abdominal infections evaluated in more than 100 hospital labs in 40 countries. They tested these bacteria for resistance to some of the most powerful antibiotics — often called "broad-spectrum" antibiotics — available. Overall, 11% of a bacteria called E. coli and almost 40% of bacteria called Klebsiella pneumoniae were resistant to cephalosporin antibiotics, the antibiotics most commonly used in children. Not surprisingly, antibiotic-resistant bacteria were more likely found in children admitted to intensive care as opposed to the general ward. Children in intensive care are more likely to receive antibiotics and stay in the hospital for prolonged periods, increasing their likelihood of being colonized with resistant bacteria. There was also variation in resistance by country, suggesting that physicians need to be aware of their own hospitals' resistance patterns to better inform their choice of antibiotic.
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