Article in Japanese

Efficacy of flomoxef monotherapy as first-line treatment for febrile urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli in young infants

Akiyoshi NARIAI¹⁾, Akiyoshi HORIE¹⁾, Tomohiro HIRADE¹⁾, Daisuke KOIKE¹⁾, Fumihide KATO²⁾

Eight febrile young infants without source were admitted to this hospital between April and May 2016.Their illness were diagnosed with febrile urinary tract infections (FUTIs) caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-producing E.coli).
In order to investigate alternative agents to carbapenems for treatment of FUTIs caused by ESBL-producing E.coli, flomoxef (FMOX) monotherapy has been selected as first-line treatment since June 2016. The total course of monotherapy for nonbacteremic FUTI is 7 days with the minimal duration for FUTIs being in accordance with the 2011 recommendation of the American Academy of Pediatrics.
This study investigated the outcome of FMOX monotherapy for FUTIs caused by ESBL-producing E.coli in 11 young infants including 2 bacteremic FUTI patients admitted from June 2016 to May 2017. The diagnosis of FUTI was made based on the presence of both pyuria and a positive monomicrobial urine culture (≥10,000 colony-forming units/mL for urine obtained by a catheter).
Fever was resolved in all the patients within 24 hours, with the mean time to alleviation of 10.7 hours. Fever in the 2 patients with bacteremic FUTI was resolved within 7 hours.
The results of this study suggest that FMOX could be a reasonable alternative agent to carbapenems for treating both nonbacteremic and bacteremic FUTIs caused by ESBL-producing E.coli in young infants.

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1) Department of Pediatrics, Shimane Central Prefectural Hospital
2) Department of Neonatology, Shimane Central Prefectural Hospital

Key words	extended-spectrum β-lactamase-producing Escherichia coli, young infants, febrile urinary tract infections, flomoxef, alternative agents to carbapenems
Received	September 3, 2018
Accepted	December 6, 2018

31 (1)：33─39,2019