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Limited use of cephalosporins may reduce E. coli and Klebsiella bloodstream infections in hospitalized children

The increasing prevalence of bloodstream infections caused by certain Escherichia coli and Klebsiella species among hospitalized patients is a growing concern. Receipt of broad-spectrum cephalosporins in the 30 days before infection by an extended-spectrum Beta-lactamase-producing (ESBL) E. coli (E) or Klebsiella (K) species is significantly associated with having an ESBL-EK bloodstream infection in hospitalized children, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10399). ESBLs are enzymes that mediate resistance to broad-spectrum cephalosporins (for example, ceftazidime, cefotaxime, and ceftriaxone).

Curtailed use of cephalosporins among high-risk groups may reduce the occurrence of these infections, conclude researchers at the Center for Education and Research on Therapeutics (CERT) at the University of Pennsylvania. They used laboratory data from the Children's Hospital of Philadelphia from May 1, 1999, to September 30, 2003, to identify children with ESBL-EK bloodstream infections and compared them with a random sample of children with non-ESBL-EK bloodstream infections to identify risk factors for such infections.

Overall, there were 35 cases and 105 controls. Patients with ESBL-EK infections were nearly six times as likely to have had exposure to a broad-spectrum cephalosporin in the 30 days before infection as those with non-ESBL-EK infections. Other independent predictors of ESBL-EK infection were female sex, infection with Klebsiella species, and steroid use in the 30 days before infection. All ESBL-EK isolates were susceptible to carbapenem antibiotics.

More details are in "Risk factors for and outcomes of bloodstream infection caused by extended-spectrum B-lactamase-producing Escherichia coli and Klebsiella species in children," by Theoklis E. Zaoutis, M.D., Monika Goyal, M.D., Jaclyn H. Chu, M.H.S., and others, in the April 2005 Pediatrics 115(4), pp. 942-949.

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