1472. Non-Carbapenems for Treating Community-Associated Urinary Tract Infection Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Children

Background Childhood urinary tract infection (UTI) may cause increased major morbidity and long-term clinical consequences. Extended-spectrum β-lactamase (ESBL) is produced by the members of the Enterobacteriaceae family, which are the primary infectious agents that cause UTI in children. Isolation of ESBL-producing Enterobacteriaceae (ESBL-E) typically occurred in healthcare facilities; however, the incidence of community-associated (CA) UTIs due to ESBL-E has increased worldwide. It has led to an increase in the use of carbapenems. In this study, we determine the characteristics of community-onset UTIs caused by ESBL-E in children to suggest non-carbapenem options for the treatment of childhood UTIs due to ESBL-E in order to preserve carbapenems. Methods A total of 2,157 isolates of ESBL-E were collected from children below 18 years old who were clinically certified UTI or urosepsis between January 2008 and August 2018 at tertiary university hospital in Korea. Their electronic medical records were retrospectively reviewed. Long-term healthcare facility stay within the preceding month and isolates recovered more than 72 hours after hospitalization were the criteria of healthcare-associated (HA) infection. Results The most common isolates were E. coli 1815 (84.2%) followed by K. pneumoniae 342 (15.8%). CA infection was detected in 1,513 of the 2157 ESBL-E (70.1%). The prevalence of CA ESBL-E infection increased significantly from 68 cases in 2008 to 325 cased in 2017. Antibiotic susceptibility test showed highest sensitivity to ertapenem, meropenem, and amikacin (>90%) followed by cefoxitin (82%), and piperacillin–tazobactam (TZP) (80.5%). CA E. coli showed higher sensitivity to amikacin and TZP compared with HA E coli. CA K. pneumoniae showed much higher sensitivity to TZP compared with HA K. pneumoniae. Of total ESBL-E, the antimicrobial resistance rate to aminoglycoside such as amikacin and gentamicin showed full sensitivity during the study period; furthermore, a rate of resistance to TZP has been decreasing over the years. Conclusion Identifying antibiotic susceptibility patterns of ESBL-E is a useful guide for treatment strategy of UTI. This study showed that there are non-carbapenem options for the treatment of CA ESBL UTI in children. Disclosures All authors: No reported disclosures.