Intestinal carriage of drug-resistant Gram-negative bacteria belonging to family Enterobacteriaceae in children aged 3–14 years: An emerging threat

Abstract

BACKGROUND: Intestinal colonization by the members of family Enterobacteriaceae represents a major step in the development of systemic infection. MATERIALS AND METHODS: A total of 100 stool samples were taken from healthy children aged between 3 and 14 years. A structured questionnaire concerning child's lifestyle, predisposing factors as well as risk factors was illustrated. Detection of microorganisms was done by standard laboratory procedures which included microscopy, culture identification, and antibiotic susceptibility testing. RESULTS: Thirty-three of 100 participants (33%) carried Escherichia coli (66.7%), Klebsiella spp. (27.3%), and Citrobacter freundii (6.1%). Underweight children showed the highest colonization rate (84.8%). Previous exposure to antimicrobial agents (60.6%), rural housing (60.6%), maternal education (57.6%), and nonimmunized status (51.5%) were significantly associated with high carriage among children. The pathogens revealed high resistance to ampicillin (E. coli, 90.9%; Klebsiella spp., 100%; and C. freundii, 100%), co-trimoxazole (E. coli, 81.8%; Klebsiella spp., 88.9%; and C. freundii, 100%), cefuroxime and cefotaxime (E. coli, 81.8% and 63.6%; Klebsiella spp., 100% and 88.9%; and C. freundii, 100% and 100%). Aminoglycoside depicted good susceptibility (gentamicin and amikacin) with resistance rates of 27.3% and 13.6% in E. coli, 33.3% and 44.4% in Klebsiella spp., and no resistance in C. freundii. Carbapenems (imipenem and meropenem) looked promising with low resistance levels (E. coli, 27.3% and 13.6%; Klebsiella spp., 33.3% and 22.2%; and C. freundii, 50% and 00%). CONCLUSION: High rate of colonization in healthy children with drug-resistant members of family Enterobacteriaceae was observed. The fecal flora of children in the community represents a huge potential reservoir of strains resistant to multiple antimicrobial agents and can be challenging to treat, as their therapeutic options are few.