Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal

Abstract

Background: The emergence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)producing uropathogens has complicated the treatment of urinary tract infections (UTI). Paediatric UTI is a common illness, which if not treated properly, may lead to acute and long-term complications, such as renal abscess, septicaemia, and renal scarring. This study aimed to determine the prevalence of MDR and ESBL-producing uropathogens among children. Methods: During the study period (April 2017-April 2018), midstream urine samples were collected following aseptic procedures from children < 16 years in Siddhi Memorial Hospital. Standard culture and biochemical tests were performed to identify uropathogens and antimicrobial susceptibility test was done by modified Kirby-Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL-producing uropathogens were screened by ceftazidime (30 μg) and cefotaxime (30 μg) discs, and confirmed by the combination disc tests: ceftazidime + clavulanic acid (30/10 μg) or cefotaxime + clavulanic acid (30/10 μg) as recommended by CLSI. Results: We processed 5545 non-repeated urine samples from the children with symptoms of UTI. A significant growth of uropathogens was observed in 203 samples (3.7%). The median age of the children was 24 months (interquartile range (IQR), 12-53 months). Escherichia coli (n = 158, 77.8%) and Klebsiella pneumoniae (n = 30, 14.8%) were common among the uropathogens. Among them, 80.3% were resistant to amoxycillin and 51.2% were resistant to cotrimoxazole. Most of them were susceptible to amikacin, nitrofurantoin, and ofloxacin. MDR was detected in 34.5% (n = 70/203) and ESBL producers in 24.6% (n = 50/203) of them. The proportion of MDR isolates was higher in children < 5 years (n = 59/153, 38.6%) than children ≥ 5 years (n = 11/50, 22%) (P = 0.03). Conclusions: Nitrofurantoin, ofloxacin, and amikacin can be used for the empirical treatment for UTI in children in Bhaktapur, Nepal. MDR and ESBL-producing uropathogens are prevalent; this warrants a continuous surveillance of antimicrobial resistance.

Antibiotic resistance patterns of urinary tract pathogens in children from Central Romania

“…Similar to other pediatric studies on the same subject (2,20,22), E. coli was the most frequently encountered etiological agent in our research as well.…”

“…coli and Klebsiella represented common uropathogens in children admitted to both nephrology departments involved. In this study, the frequency of infection with E. coli and Klebsiella were similar with studies from Nepal and Turkey (20,21).…”

“…Our study indicates that nitrofurantoin, ceftriaxon, amikacin, and carbapenem may be used for the empirical treatment of febrile or complicated UTIs in children. Our study results are comparative with those achieved by Raya et al (20).…”

Detection of TEM and CTX-M Genes in Escherichia coli Isolated from Clinical Specimens at Tertiary Care Heart Hospital, Kathmandu, Nepal

“…Higher rates of ESBLs have been reported from Southeast Asia, including Nepal [14]. Various studies have reported the circulation of ESBL-producing bacterial strains in Nepal [3,6,[15][16][17][18]. Laboratory facilities for culture and antimicrobial susceptibility testing in different peripheral/district hospitals are still not available in Nepal.…”

“…Failure to identify ESBL-producing organisms contributes to their uncontrolled spread [12]. Identification of the resistant phenotype is crucial in preventing the AMR, more so in developing countries, where there is excessive use of antibiotics and a lack of adequate antimicrobial resistance surveillance [11,17]. The main objective of this study was to explore the prevalence of ESBL-producing Gram-negative bacteria, their antibiogram, and molecular detection of plasmid-mediated ESBL genes bla TEM and bla CTX-M in E. coli among patients suspected of heart infections at Gangalal Heart Hospital, Kathmandu, Nepal.…”