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MICROBIOLOGICALLY APPROPRIATE AND INAPPROPRIATE EMPIRIC ANTIBIOTIC THERAPY IN PEDIATRIC FEBRILE ESCHERICHIA COLI URINARY TRACT INFECTIONS: A RETROSPECTIVE STUDY COMPARING IN VIVO AND IN VITRO EFFICACY
Abstract
Background
Urinary tract infections (UTIs) are among the most common bacterial infections in children and E.coli is the main responsible pathogen. Given the current increasing rates of antibiotic resistance worldwide, the choice of empiric therapy (ET) often results inappropriate.
Aims
To compare clinical efficacy of ET in pediatric patients with UTIs caused by an E.coli strain that turned out to be resistant to the ET in vitro (inappropriate ET, IET), to that of patients treated with an appropriate ET (AET), according to the antimicrobial susceptibility testing (AST) results.
Methods
We conducted a retrospective study on pediatric patients admitted to our Pediatric ward for an E.coli febrile UTI, over the period 2016-2020. The clinical efficacy of ET was assessed as time to defervescence, improvement of inflammatory blood markers, length of hospitalization (LOH), need of antibiotic prophylaxis and short and long-term complications.
Results
We enrolled 106 patients (median [IQR] age: 6.0 [3.0-14.3] months). Twenty-one (19.8%) patients underwent an IET. The comparison between IET and AET groups did not show any statically significant difference in terms of clinical efficacy. Within the IET group we compared patients who underwent a switch of the therapy, according to AST results, to those who did not. Within these 2 subgroups, 8/13 (61.5%) and 8/8 (100%) patients, respectively had defervescence before AST results. No differences were found in terms of clinical efficacy, except for the LOH as expected.
Conclusions
According to our findings, in vitro resistance of E.coli to ET did not affect the clinical outcome of pediatric patients with febrile UTIs who underwent an IET.