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Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone.

ABSTRACT: Among hospitalized children with parapharyngeal or retropharyngeal infection, multivariate analysis was performed for the outcomes: successful treatment with antibiotics alone, absence of complications and length of stay less than 3 days. Those with apparent abscess on computed tomography scan had a lower probability of treatment with antimicrobials alone while older age was associated with increased probability of treatment with antibiotics alone.

SUBMITTER: Bolton M

PROVIDER: S-EPMC4151323 | biostudies-literature | 2013 Sep

REPOSITORIES: biostudies-literature

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Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone.

Bolton Michael M Wang Wei W Hahn Andrea A Ramilo Octavio O Mejias Asuncion A Jaggi Preeti P

The Pediatric infectious disease journal 20130901 9

Among hospitalized children with parapharyngeal or retropharyngeal infection, multivariate analysis was performed for the outcomes: successful treatment with antibiotics alone, absence of complications and length of stay less than 3 days. Those with apparent abscess on computed tomography scan had a lower probability of treatment with antimicrobials alone while older age was associated with increased probability of treatment with antibiotics alone. ...[more]

PMID: 23538517

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Project description:Abstract Background Escherichia coli and Klebsiella pneumoniae with a piperacillin-tazobactam–nonsusceptible/ceftriaxone-susceptible (TZP-NS/CRO-S) phenotype have been increasingly identified, with limited available literature evaluating treatment strategies. Methods This was a retrospective study of noncritically ill adults hospitalized between 2013 and 2021 and treated at least 48 hours for TZP-NS/CRO-S E coli or K pneumoniae infections. The primary composite endpoint included escalation to intensive care unit, infection- or treatment-related readmission, mortality, and infection recurrence. Outcomes were compared between groups who received carbapenem (CG) versus carbapenem-sparing agents (CSG) as targeted gram-negative therapy. Results Of 1062 patients screened, 200 were included (CG, n = 51; CSG, n = 149). Baseline characteristics, including Charlson Comorbidity Index (CCI; median [interquartile range], 6 [3–9] vs 6 [4–9]; P = .704), were similar between groups, except for more immunocompromised CG patients (29% vs 11%, P = .001). The most common infection sources were urinary (31% vs 57%, P = .002) and bloodstream (18% vs 17%, P = .887). Eighty-eight percent of the CG received meropenem, while 58% of the CSG received ceftriaxone as targeted therapy. There was no statistical difference in the primary endpoint between overall groups (27% vs 17%, P = .123), nor when stratified by infection source. More patients in the CSG switched to oral therapy (15 [29%] vs 100 [67%], P < .001). In multivariate analysis, CCI was an independent predictor of the primary outcome (odds ratio [OR], 1.199 [95% confidence interval, 1.074–1.340]; P = .001), while treatment with carbapenem-sparing therapy was not. Conclusions Our study did not find improved clinical outcomes with targeted carbapenem therapy for TZP-NS/CRO-S infections. Carbapenem-sparing agents may be considered to spare carbapenems in noncritically ill patients similar to those included in our cohort. Piperacillin-tazobactam–nonsusceptible/ceftriaxone-susceptible Enterobacterales have been increasingly identified in the New York metropolitan area. In noncritically ill patients with uncomplicated infections of this phenotype, carbapenem-sparing agents, including third-generation cephalosporins, may be considered.

Dataset Information

Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone.

Publications

Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone.

Similar Datasets

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