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.
Highlights
Emergence of Extended-spectrum beta-lactamase producing Escherichia coli causing urinary tract infections (UTI) among pediatric patients is an increasing problem worldwide
Antimicrobial susceptibility testing The susceptibility of bacterial isolates against different antibiotics was tested by the disk diffusion method [modified Kirby-Bauer method] on Mueller Hinton agar (Hi-Media, India) following standard procedures recommended by the Clinical and Laboratory Standards Institute (CLSI), Wayne, USA [16]
Escherichia coli (n =739, 68.5%) was the most common organism isolated from urinary tract infections in pediatric group in this study
Summary
Emergence of Extended-spectrum beta-lactamase producing Escherichia coli causing urinary tract infections (UTI) among pediatric patients is an increasing problem worldwide. Extended-spectrum β-lactamase (ESBL), a major beta lactamase enzyme, Parajuli et al Antimicrobial Resistance and Infection Control (2017) 6:9 has the ability to hydrolyze oxyimino-cephalosporins, and monobactams but not cephamycins or carbapenems and inhibited in-vitro by inhibitors such as clavulanic acid, sulbactam and tazobactam [8]. Since their evolution in 1983, more than 300 types of ESBLs have been identified in various members of the family Enterobacteriaceae and other non-enteric organisms [3, 6]. Options for the treatment of such multidrug resistant (MDR) gram negative bacterial infections are generally limited, and very few antibiotics are approved for use in children [10]
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