High rates of multidrug resistance among uropathogenic Escherichia coli in children and analyses of ESBL producers from Nepal

Abstract

BackgroundEmergence of Extended-spectrum beta-lactamase producing Escherichia coli causing urinary tract infections (UTI) among pediatric patients is an increasing problem worldwide. However, very little is known about pediatric urinary tract infections and antimicrobial resistance trend from Nepal. This study was conducted to assess the current antibiotic resistance rate and ESBL production among uropathogenic Escherichia coli in pediatric patients of a tertiary care teaching hospital of Nepal.MethodsA total of 5,484 urinary tract specimens from children suspected with UTI attending a teaching hospital of Nepal over a period of one year were processed for the isolation of bacterial pathogens and their antimicrobial susceptibility testing. Escherichia coli (n = 739), the predominant isolate in pediatric UTI, was further selected for the detection of ESBL-production by phenotypic combination disk diffusion test.ResultsIncidence of urinary tract infection among pediatric patients was found to be 19.68% and E coli (68.4%) was leading pathogen involved. Out of 739 E coli isolates, 64.9% were multidrug resistant (MDR) and 5% were extensively drug resistant (XDR). Extended spectrum beta lactamase (ESBL) was detected in 288 (38.9%) of the E coli isolates.ConclusionAlarming rate of drug resistance among pediatric uropathogens and high rate of ESBL-producing E. coli was observed. It is extremely necessary to routinely investigate the drug resistance among all isolates and formulate strict antibiotics prescription policy in our country.

ESBL Production Among E. coli and Klebsiella spp. Causing Urinary Tract Infection: A Hospital Based Study

“…The findings are in agreement with the study [11], however, contrary to the findings of other study [47] of 365 E. coli isolates, 33 (9.0%) were ESBL producers. This accords with the other studies [33, 35, 41, 48], however, discords with following studies [22, 24, 29-32, 36-38]. Likewise, of 20 Klebsiella spp.…”

“…E. coli, including other enterobacteria, are likely to have caused infection after colonization of the periurethral area by gastrointestinal tract flora [27]. This accords with other studies [21, 22, 24, 28-34]. However, discords with following studies [35-38].…”

Enhanced quantitative urine culture technique, a slight modification, in detecting under-diagnosed pediatric urinary tract infection

“…The analogous rates have been reported earlier from neighboring hospitals [4][5][6] and studies from other nations [9,10]. Alongside, significantly more females up to 72.0% had UTI substantiating with other similar studies [5,6]. In our study, the children of the age group 1-4 years were more prone to the infection.…”

“…Although, the documented incidence of the infection ranges from 23.1 to 37.4% in the Nepalese population [4]. In Nepal, and most developing countries, the pediatric UTIs cases are treated empirically due to lacking appropriate diagnostic protocol, unavailability of standard therapeutic guidelines, and undocumented resistivity trend of the pathogens in local and regional levels [4][5][6]. Therefore, a precise diagnosis of the etiologies and its resistivity status against the preferred antibiotics is crucial for successful clinical management and prophylaxis.…”

Antibiotic sensitivity pattern for non-beta lactam antibiotics and carbapenems in extended-spectrum beta-lactamase (ESBL) producing uropathogens versus non-ESBL producing uropathogens

“…4,5 Along with increasing antibiotic resistance, extended spectrum beta lactamase (ESBL) producers have been increasing. 6,7 Gram-negative organisms, in particular, members of the Enterobacteriaceae family, e.g. E. coli and Klebsiella species, produce β-lactamases with an extended spectrum of activity.…”