Outcome of children with ESBL-E. coli acute pyelonephritis treated with cephalosporins

Abstract Background Some reports have demonstrated surprising efficacy of cephalosporins in acute pyelonephritis (APN) caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria. Methods We analyzed clinical and microbiological data of pediatric ESBL-APN patients treated empirically with cephalosporins. APN was defined as a combination of fever, pyuria u003e50 × 10*6/l, bacteriuria, abnormal C-reactive protein (CRP) and no signs of other focus of infection. For a subgroup of children with no co-morbidities, we selected age- and gender-matched controls with APN caused by a non-ESBL Escherichia coli to compare outcomes. Results The study group consisted of 34 children with ESBL-APN (13 boys and 21 girls, median age 1.0 years, range 0.1-9.0 years). The majority of children (88%, 30/34) recovered clinically on the empiric suboptimal antibiotic therapy, being afebrile at ≤48 hours of treatment. Microbiological recovery was documented in seven patients while on therapy with suboptimal antibiotics (64%, 7/11). CRP kinetics, duration of hospitalization, clinical recovery and recurrence rates were similar in children with no co-morbidities in ESBL-APN (n=27) and non-ESBL-APN (n=27) groups. Conclusions Most children with ESBL-APN recovered on empiric therapy with cephalosporins. Clinical recovery, duration of hospitalization and recurrence rates were similar in ESBL- and non-ESBL-APN groups of children.