<p>Antimicrobial Resistance and Resistance Determinant Insights into Multi-Drug Resistant Gram-Negative Bacteria Isolates from Paediatric Patients in China</p>

Abstract

IntroductionThe emergence of multi-drug-resistant Gram-negative bacteria (GNB) is a concern in China and globally. This study investigated antimicrobial resistance traits and resistance determinant detection in GNB isolates from paediatric patients in China.MethodsIn the present study, a total of 170 isolates of GNB including the most prevalent Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii were collected from Shenzhen Children’s Hospital, China. ESBLs production was confirmed by using the combination disc diffusion method, and carbapenemase production was confirmed by using a carbapenem inactivation method followed by antimicrobial susceptibility. In addition, β-lactamase-encoding genes and co-existence of plasmid-borne colistin resistance mcr-1 gene were determined by PCR and sequencing.ResultsOverall, 170 etiological agents (GNB) were recovered from 158 paediatric patients. The most prevalent species was E. coli 40% (n=68), followed by K. pneumoniae 17.64% (n=30), and Enterobacter cloacae 14.11% (n=24). Of 170 GNB, 71.76% (n=122) were multi-drug-resistant, 12.35% (n=21) extreme-drug resistant, and 7.64% (n=13) single-drug-resistant, while 8.23% (n=14) were sensitive to all of the studied antibiotics. The prevalence of ESBLs and carbapenemase producers were 60% and 17%, respectively. blaCTX-M was the most prevalent resistance gene (59.42%), followed by blaTEM (41.17%), blaSHV (34.270%), blaKPC (34.11%), blaOXA-48 (18.82%) and blaNDM-1 (17.64%).ConclusionThe present study provides insights into the linkage between the resistance patterns of GNB to commonly used antibiotics and their uses in China. The findings are useful for understanding the genetics of resistance traits and difficulty in tackling of GNB in paediatric patients.

Global emerging resistance in pediatric infections with TB, HIV, and gram-negative pathogens

“…In a study at a children's hospital in China, ~72% of gram-negative bacilli were found to be MDR, with ESBLs being most prevalent [72]. Other studies have demonstrated similar findings [73].…”

Phenotypic and genotypic characterization of antibiotic resistant gram negative bacteria isolated in Tabuk City, Saudi Arabia

“…Antimicrobial resistance is described as a condition in which the pathogens escape from the stress of the antibiotic exposure (Alam et al, 2017). The increasing incidence of antimicrobial resistance is a key concern globally and considered main obstacle in the treatment of patients suffering from bacterial infections (Patil et al, 2019). It has been estimated that about 1.3 to 2 fold rise in mortality is caused by antimicrobial resistant bacteria compared to susceptible infections (Alam et al, 2017).…”

“…It has been estimated that about 1.3 to 2 fold rise in mortality is caused by antimicrobial resistant bacteria compared to susceptible infections (Alam et al, 2017). A dramatic evolution has occurred in the significance of infections caused by Gram-negative bacteria (GNB) and associated with considerable mortality (Alam et al, 2017;Patil et al, 2019;Paterson, 2008). The efficiency of the current prophylactic and empiric antibiotic treatment is compromised by the emergence of pan drug resistant (PDR), extensively drug resistant (XDR) and multidrug resistant (MDR) Gram-negative bacteria (GNB) (Patil et al, 2019;Paterson, 2008).…”

“…A dramatic evolution has occurred in the significance of infections caused by Gram-negative bacteria (GNB) and associated with considerable mortality (Alam et al, 2017;Patil et al, 2019;Paterson, 2008). The efficiency of the current prophylactic and empiric antibiotic treatment is compromised by the emergence of pan drug resistant (PDR), extensively drug resistant (XDR) and multidrug resistant (MDR) Gram-negative bacteria (GNB) (Patil et al, 2019;Paterson, 2008). The ability to escape from the antimicrobial effects may have contributed to the nature of these organisms, which are heterogeneous, complex group of plasmids-borne and rapidly evolving enzymes which are capable of hydrolyzing cephalosporins, penicillins, aztreonam and monobactams (Fernando et al, 2017;Provenzani et al, 2020).…”

“…Three of these six pathogens are antibiotic resistant Gram-negative bacteria: Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae (Lee et al, 2007). ESBLs have been classified into three major groups: bla SHV, bla CTX-M and bla TEM (Patil et al, 2019). Ting et al (2013) stated that bla TEM, bla SHV and bla CTX-M genes are super-resistant extended spectrum lactamases.…”