Epidemiology of community origin of major multidrug-resistant ESKAPE uropathogens in a paediatric population in South-East Gabon

Abstract

Background Urinary tract infections (UTIs) in children are very common. They are often associated with a high risk of sepsis and death. In recent years, antibiotic-resistant uropathogens ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae) are increasingly encountered in UTIs. These bacteria, usually multidrug-resistance (MDR), extensive drug-resistance (XDR), pandrug-resistance (PDR), Extended-spectrum cephalosporin-resistance (ESC), Usual Drug Resistance (UDR), Difficult-to-Treat Resistance (DTR) and Carbapenem-resistance Enterobacteriales (CRE), represent a global threat for the management of paediatric UTIs. The aim of this study was to determine the epidemiology of community origin and antibiotic sensitivity of major ESKAPE uropathogens in paediatric UTIs in South-East Gabon. Methods The study involved 508 children aged 0–17 years. Identification of bacterial isolates was carried out using Vitek-2 compact automated system and the antibiogram with the disk diffusion and microdilution methods according to the European Committee on Antimicrobial Susceptibility Testing recommendations. Logistic regression analysis was used to assess the impact of patients' socio-clinical characteristics on uropathogens phenotype in both univariate and multivariate analysis. Results The prevalence of UTIs was 59%. E. coli (35%) and K. pneumoniae (34%) were the main ESKAPE involved in UTIs followed by Enterococcus spp. (8%) and S. aureus (6%). Among major ESKAPE, DTR-E. coli (p = 0.01), CRE-E. coli (p = 0.02) and XDR-E. coli (p = 0.03), Trimethoprim-sulfamethoxazole-resistant bacteria (p = 0.03) were associated with abdomino-pelvic pain. While MDR-E. coli (p < 0.001), UDR-E. coli (p = 0.02), ESC-E. coli (p < 0.001), MDR- Enterococcus (p = 0.04), UDR- Enterococcus (p = 0.02), bacteria resistant to Ampicillin (p < 0.01), Cefotaxime (p = 0.04), Ciprofloxacin (p < 0.001), Benzylpenicillin (p = 0.03) and Amikacin (p = 0.04) were more frequent among male children. MDR-Enterococcus (p < 0.01), bacteria resistant to Amoxicillin-clavulanic acid (p = 0.03), Cefalotin (p = 0.01), Ampicillin (p = 0.02) and Gentamicin (p = 0.03) were associated with treatment failure. In addition, Trimethoprim-sulfamethoxazole-resistant bacteria (p = 0.03) was associated with recurrent UTIs while those resistant to Ciprofloxacin was associated with pollakiuria (p = 0.01) and urinary burning (p = 0.04). Furthermore, UDR-K. pneumoniae (p = 0.02) was more frequent in neonates and infants. Conclusion This study determined the epidemiology of ESKAPE uropathogens in paediatric UTIs. It found a high prevalence of paediatric UTIs associated with children’s socio-clinical characteristics and diverse bacterial antibiotic resistance phenotypes.

Gram-Negative ESKAPE Bacteria Surveillance in COVID-19 Pandemic Exposes High-Risk Sequence Types of Acinetobacter baumannii MDR in a Tertiary Care Hospital

“…In 2008, Rice first coined the acronym ESKAPE for a group of bacteria that in addition to being multidrug-resistant by "escaping antimicrobial therapy", it was observed that it was a group of bacteria prevalent as causative agents of healthcare-associated infections (HAIs). This observation, which was not so obvious to many, served to focus the attention of several hospital centers around the world on this group of microorganisms, calling them "ESKAPE pathogens" [1][2][3][4][5][6][7]. During the COVID-19 pandemic, this bacterial group was one of the main agents causing co-infections in critically ill patients, where ventilator-associated pneumonia (VAP) was the most important HAI due to the drug resistance identified in these isolates, as well as a generator of hospital outbreaks [8][9][10].…”

Carbapenem-producing Enterobacteriaceae in mothers and newborns in southeast Gabon, 2022

“…Despite an increasing number of reports on CPE in Central Africa ( Moussounda et al., 2017 ; Singh et al., 2018 ; Okomo et al., 2019 ; Mouanga-Ndzime et al., 2023 ), there is a notable gap in the literature concerning epidemiological studies focused on the carriage and infection rates of CPE among mothers and newborns in maternity hospitals, as well as the contamination of the care environment by these pathogens. In 2016, a prevalence study conducted at the military hospital in Libreville identified the presence of K. pneumoniae bla NDM-7 in three out of seven newborns present.…”