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Etiology, Extended-spectrum β-lactamase Rates and Antimicrobial Susceptibility of Gram-negative Bacilli Causing Intra-abdominal Infections in Patients in General Pediatric and Pediatric Intensive Care Units—Global Data From The Study for Monitoring Antimicrobial Resistance Trends 2008 to 2010

Badal, Robert E. BS*; Bouchillon, Samuel K. MD*; Lob, Sibylle H. MD, MPH*; Hackel, Meredith A. PhD, MPH*; Hawser, Stephen P. PhD; Hoban, Daryl J. PhD*

The Pediatric Infectious Disease Journal: June 2013 - Volume 32 - Issue 6 - p 636–640
doi: 10.1097/INF.0b013e3182886377
Original Studies

Background: Antimicrobial resistance has been increasing for several years and is often higher in intensive care units (ICUs) than in other facilities. The spread of extended-spectrum β-lactamases (ESBLs) in particular has profoundly impacted antimicrobial efficacy and usage. The Study for Monitoring Antimicrobial Resistance Trends has monitored the in vitro activity of ertapenem and several comparators against aerobic gram-negative bacteria from intra-abdominal infections (IAIs) for many years. This report summarizes susceptibility levels and epidemiology for key IAI pathogens cultured from general pediatric medical wards and pediatric ICUs globally.

Methods: 1248 gram-negative bacteria were collected from pediatric IAIs by 113 labs in 40 countries from 2008 to 2010. Susceptibility was determined by Clinical and Laboratory Standards Institute broth microdilution. Susceptibility rates (%S) were determined for species with ≥10 isolates.

Results: Sixty-two percent of isolates came from general pediatric wards and 38% from pediatric ICUs. The overall ESBL-positive rate was 11.0% for Escherichia coli and 38.9% for Klebsiella pneumoniae; the ESBL-positive rate for E. coli was twice as high in ICU as non-ICU. Most study drugs inhibited >90% of ESBL-negative isolates, but only the carbapenems inhibited >90% of ESBL-positive E. coli and only imipenem inhibited >90% of ESBL-positive K. pneumoniae.

Conclusions: Amikacin, imipenem and ertapenem were the most active against gram-negative bacteria from pediatric IAIs, followed closely by the fluoroquinolones and cefepime. Other cephalosporins were often <90% active. ESBL rates were 38.9% for K. pneumoniae and 11.0% for E. coli. Therapy for pediatric IAIs should take into consideration local ESBL rates because only carbapenems inhibited most of these pathogens.

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From the *International Health Management Associates, Inc., Schaumburg, IL; and IHMA Europe Sàrl, Epalinges, Switzerland.

Accepted for publication January 17, 2013.

This work was presented, in part, as Poster 907 at the 49th Annual Meeting of the Infectious Diseases Society of America, Boston, October 20–23, 2011.

All of the authors are employed by IHMA, Inc. or its subsidiary, IHMA Europe Sàrl; IHMA receives funding from Merck & Co., Inc. to manage all aspects of the SMART program. The authors have no other funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Robert E. Badal, BS, 836 Klein Way, Sacramento, CA 95831. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.