Srpski arhiv za celokupno lekarstvo 2012 Volume 140, Issue 5-6, Pages: 321-325
https://doi.org/10.2298/SARH1206321P
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In vivo susceptibility of ESBL producing Escherichia coli to ceftriaxone in children with acute pyelonephritis
Peco-Antić Amira (Medicinski fakultet, Beograd + Univerzitetska dečja klinika, Beograd)
Paripović Dušan (Univerzitetska dečja klinika, Beograd)
Buljugić Svetlana (Univerzitetska dečja klinika, Beograd)
Spasojević-Dimitrijeva Brankica (Univerzitetska dečja klinika, Beograd)
Cvetković Mirjana (Univerzitetska dečja klinika, Beograd)
Laban-Nestorović Suzana (Univerzitetska dečja klinika, Beograd)
Miloševski-Lomić Gordana (Univerzitetska dečja klinika, Beograd)
Introduction. The choice of empiric therapy of acute pyelonephritis (APN) in
children should be based on the knowledge of Escherichia coli (E. coli) as
the most common uropathogen and its antibiotic sensitivities considering that
nowadays ESBL-producing [ESBL (+)] E. coli is on the rise worldwide.
Objective. To examine in vivo susceptibility of ESBL (+) E. coli to
ceftriaxone (CTX), and to evaluate the options for empiric therapy for APN in
children. Methods. Retrospective study of CTX empiric therapy of APN in
children treated at the University Children΄s Hospital in Belgrade from
January 2005 to December 2009. ESBL phenotypic confirmatory test with
ceftazidime, CTX and cefotaxime was performed for all urine isolates by disc
diffusion method on Mueller-Hinton agar plates. In vivo sensitivity of CTX
documented by clinical response to empiric CTX therapy was compared between
two groups of children: group I with ESBL (+) E. coli and group II with ESBL
(-) E. coli APN. Results. Group I with ESBL (+) APN consisted of 94 patients
and group II of 120 patients with ESBL (-) APN, respectively. All patients
received CTX as empiric therapy at a mean dose of 66.9 mg during 7.2±2.6 days
of therapy. Clinical effect of CTX was similar in patients with ESBL (+)
compared to those with ESBL (-) APN. Conclusions. In vitro resistance of ESBL
E. coli to CTX determined by standard methods is not sufficiently predictive
for its in vivo sensitivity. Therefore CTX may be used as empiric therapy for
acute pyelonephritis in children.
Keywords: empiric antibacterial therapy, acute pyelonephritis, Escherichia coli, extended spectrum β-lactamases, children