1509. Outcomes of Empirical Antimicrobial Therapy for Pediatric Community-Onset Febrile Urinary Tract Infection in the Era of Increasing Antimicrobial Resistance

Abstract

BackgroundUrinary tract infection (UTI) is a common cause of fever in children. Since infections caused by extended-spectrum β-lactamase (ESBL)-producing organism in the community have increased, alternative empirical antimicrobials to carbapenems have been studied. We conducted this study to compare clinical outcomes between group receiving empirical antimicrobials to which organisms were susceptible vs. non-susceptible in community-onset UTI.MethodsWe conducted a retrospective cohort study of pediatric patients with first-episode community-onset febrile UTI caused by Escherichia coli, Klebsiella pneumoniae and Proteus spp. at Ramathibodi Hospital from 2011 to 2017. Patients were classified into group receiving empirical antimicrobials to which organisms were susceptible and non-susceptible. Medical records were reviewed to assess clinical outcomes in both groups.ResultsOne hundred and fifty-one eligible patients were enrolled in this study. The most common causative organism was E. coli (89.6 and 96.2% in the group receiving susceptible and non-susceptible antimicrobials, respectively). Among causative organisms, 19.8% were ESBL-producing organisms. Ceftriaxone was used in 76.8% of our patients. There was no significant difference in clinical, microbiological, relapse, time to defervescence between two groups of patients. None of patients in both groups developed sepsis after receiving empirical therapy. However, length of stay was significantly longer in group receiving antimicrobials to which organisms were non-susceptible (5.12 ± 3.187 vs. 8.54 ± 5.186, P = 0.008).ConclusionThis study found no significant difference in the treatment outcomes between pediatric patients receiving antimicrobials to which organisms were susceptible and non-susceptible for the treatment of UTI.In the era of increasing antimicrobial resistance, third-generation cephalosporins are still a good choice as an empirical antimicrobial for children with community-onset UTI.Disclosures All authors: No reported disclosures.