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Treatment and Outcomes of Children With Febrile Urinary Tract Infection Due to Extended Spectrum Beta-lactamase-producing Bacteria in Europe: TOO CUTE Study

Vazouras K, Hsia Y, Folgori L, Bielicki J, Aguadisch E, Bamford A, Brett A, Caseris M, Cerkauskiene R, De Luca M, Iosifidis E, Kopsidas J, Manzanares Á, Planche T, Riordan A, Srovin TP, Valdivielso Martínez AI, Vergadi E, Sharland M, Basmaci R.   

Pediatric Infectectius Diseases Journal, 2020 Dec;39(12):1081-1087. DOI:https://doi: 10.1097/INF.0000000000002838

Abstract 

Background: The prevalence of extended-spectrum beta-lactamase producing Εnterobacteriaceae (ESBL-PE) is increasing globally. ESBL-PE are an important cause of urinary tract infections (UTIs) in children. We aimed to characterize the clinical presentation, treatment and outcomes of child-hood UTI caused by ESBL-PE in Europe.

Methods: Multicenter retrospective cohort study. Children 0 to 18 years ofage with fever, positive urinalysis and positive urine culture for an ESBL-PE uropathogen, seen in a participating hospital from January 2016 to July2017, were included. Main Outcome Measures: Primary outcome measure: day of defervescence was compared between (1) initial microbiologically effective treat-ment (IET) versus initial microbiologically ineffective treatment (IIT) and (2) single initial antibiotic treatment versus combined initial antibiotic treat-ment. Secondary outcome measures: Clinical and microbiologic failure ofinitial treatment.

Results: We included 142 children from 14 hospitals in 8 countries. Sixty-one children had IET and 77 IIT. There was no statistical difference in time to defervescence for effective/ineffective groups (P= 0.722) and single/combination therapy groups (P= 0.574). Two of 59 (3.4%) and 4/66 (6.1%) patients exhibited clinical failure during treatment (P= 0.683) when receiving IET or IIT, respectively. Eight of 51 (15.7%) receiving IET and 6/58 (10.3%) receiving IIT patients (P= 0.568) had recurring symptoms/signssuggestive of a UTI. Recurrence of a UTI occurred 15.5 days (interquartilerange, 9.0–19.0) after the end of treatment.

Conclusions: Time to defervescence and clinical failure did not differ between IET/IIT groups. Non-carbapenem beta-lactam antibiotics may be used for the empiric treatment of ESBL febrile UTIs, until susceptibility testing results become available.