907. Intra-abdominal Pathogens from General Pediatric Wards and Pediatric ICUs: Etiology, ESBL Rate, and Antimicrobial Susceptibility - SMART 2008-2010
Session: Poster Abstract Session: Antimicrobial Utilization and Resistance in Children
Saturday, October 22, 2011
Room: Poster Hall B1

Background: The Study for Monitoring Antimicrobial Resistance Trends (SMART) has monitored activity of amikacin (AK), ampicillin-sulbactam (AS), cefepime (CPE), cefotaxime (CFT), cefoxitin (CFX), ceftazidime (CAZ), ceftriaxone (CAX), ciprofloxacin (CP), ertapenem (ETP), imipenem (IMP), levofloxacin (LVX), and piperacillin-tazobactam (PT) vs. aerobic gram-negative bacteria (GNB) from intra-abdominal infections (IAIs) since 2002. This report summarizes susceptibility levels and epidemiology for key IAI pathogens cultured from general pediatric medical wards and pediatric ICUs globally.

Methods: 1,155 GNB were collected from pediatric IAIs by 146 labs in 43 countries from 2008 to 2010.  MICs were determined by broth microdilution and interpreted using CLSI guidelines. Susceptibility rates (%S) for isolates were determined for species with ≥10 isolates. 

Results:  61% of isolates came from general pediatric wards and 39% from pediatric ICUs.  Overall ESBL+ rate was 9.7% for E. coli, and 37.3% for K. pneumoniae.  The susceptibilities of the top 10 species are listed in the table below with %S ≥90 bolded.

Rank

Organism

n

AS

AK

CAX

CAZ

CFT

CFX

CP

CPE

ETP

IMP

LVX

PT

1

E. coli, non ESBL

570

49

99

96

96

95

94

91

99

99

99

92

94

1

E. coli, ESBL

61

10

84

0

23

0

85

34

13

93

98

36

82

2

K. pneumoniae, non ESBL

79

68

94

91

91

90

87

92

95

92

95

95

89

2

K. pneumoniae, ESBL

47

2

72

6

9

6

81

53

28

87

96

77

45

3

P. aeruginosa

116

na

91

13

79

8

na

85

84

na

85

86

88

4

E. cloacae

78

18

97

49

54

49

9

95

86

68

97

97

67

5

K. oxytoca, non ESBL

43

67

100

88

98

95

93

98

98

98

100

100

91

5

K. oxytoca, ESBL*

1

0/1

1/1

0/1

0/1

0/1

1/1

1/1

1/1

1/1

1/1

1/1

1/1

6

A. baumannii

24

42

38

38

46

46

na

38

33

na

58

50

42

7

E. aerogenes

22

14

100

32

32

27

14

82

82

77

95

95

55

8

P. mirabilis

22

77

95

95

95

95

95

86

100

95

32

86

100

9

C. freundii

18

39

83

61

61

56

11

72

83

94

100

83

72

10

S. marcescens

15

27

100

87

87

80

67

93

93

100

93

100

87

* %S not calculated for n<10; n inhibited/total n are shown; na=not applicable.

Conclusion: AK, IMP, and ETP and were the most active drugs in vitro against GNB from pediatric IAIs, followed closely by the fluoroquinolones and PT. 3rd and 4th gen. cephalosporins were often <90% active. ESBL rates were 37.3% for K. pneumoniae and 9.7% for E. coli. Therapy for pediatric IAIs should take into consideration local ESBL+ rates since only IMP and ETP inhibited most of these pathogens.

 


Subject Category: P. Pediatric and perinatal infections

Samuel Bouchillon, MD, Robert Badal, BS, Meredith Hackel, PhD and Daryl Hoban, PhD, IHMA, Inc., Schaumburg, IL

Disclosures:

S. Bouchillon, Merck & Co, Inc.: Consultant, Consulting fee

R. Badal, Merck & Co, Inc.: Consultant, Consulting fee

M. Hackel, Merck & Co, Inc.: Consultant, Consulting fee

D. Hoban, Merck & Co, Inc.: Consultant, Consulting fee

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.