Abstract
BackgroundThe β-lactam antibiotics have traditionally been the main treatment of Enterobacteriaceae infections, nonetheless, the emergence of species producing β- Lactamases has rendered this class of antibiotics largely ineffective. There are no published data on etiology of urinary tract infections (UTI) and antimicrobial resistance profile of uropathogens among children in Qatar. The aim of this study is to determine the phenotypic and genotypic profiles of antimicrobial resistant Enterobacteriaceae among children with UTI in Qatar.MethodsBacteria were isolated from 727 urine positive cultures, collected from children with UTI between February and June 2017 at the Pediatric Emergency Center, Doha, Qatar. Isolated bacteria were tested for antibiotic susceptibility against sixteen clinically relevant antibiotics using phoenix and Double Disc Synergy Test (DDST) for confirmation of extended-spectrum beta-lactamase (ESBL) production. Existence of genes encoding ESBL production were identified using polymerase chain reaction (PCR). Statistical analysis was done using non-parametric Kappa statistics, Pearson chi-square test and Jacquard’s coefficient.Results201 (31.7%) of samples were confirmed as Extended Spectrum β -Lactamases (ESBL) Producing Enterobacteriaceae. The most dominant pathogen was E. coli 166 (83%) followed by K. pneumoniae 22 (11%). Resistance was mostly encoded by bla CTX-M (59%) genes, primarily bla CTX-MG1 (89.2%) followed by bla CTX-MG9 (7.7%). 37% of isolated bacteria were harboring multiple bla genes (2 genes or more). E. coli isolates were categorized into 11 clusters, while K. pneoumoniae were grouped into five clonal clusters according to the presence and absence of seven genes namely bla TEM, bla SHV, bla CTX-MG1, bla CTX-MG2, bla CTX-MG8 bla CTX-MG9,bla CTX-MG25.ConclusionsOur data indicates an escalated problem of ESBL in pediatrics with UTI, which mandates implementation of regulatory programs to reduce the spread of ESBL producing Enterobacteriaceae in the community. The use of cephalosporins, aminoglycosides (gentamicin) and trimethoprim/sulfamethoxazole is compromised in Qatar among pediatric population with UTI, leaving carbapenems and amikacin as the therapeutic option for severe infections caused by ESBL producers.
Highlights
The β-lactam antibiotics have traditionally been the main treatment of Enterobacteriaceae infections, the emergence of species producing β- Lactamases has rendered this class of antibiotics largely ineffective
extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae were more prevalent among Qataris 46 (22.8%), Egyptians 37 (18.4%), Indians 27 (13.4%), and to lesser extent in Pakistani 21(10.4%)
We found that the majority of ESBL (156, 77.6%) producers were multidrug resistant, with the most common resistance pattern being to amoxicillin-clavulanate, ampicillin, ciprofloxacin, Sulfamethoxazole/trimethoprim in addition to cephalosporines
Summary
The β-lactam antibiotics have traditionally been the main treatment of Enterobacteriaceae infections, the emergence of species producing β- Lactamases has rendered this class of antibiotics largely ineffective. The aim of this study is to determine the phenotypic and genotypic profiles of antimicrobial resistant Enterobacteriaceae among children with UTI in Qatar. Over the past two decades, there has been an exponential increase in β-lactamase resistance worldwide accompanied with a significant escalation in the prevalence of ESBL-producing Enterobacteriaceae [5]. ESBL-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the predominant organisms in childhood infections, and they pose significant threat to human health [13]. These organisms are listed among the pathogens for which there are few potentially effective drugs [1]. About 57% of bloodstream infections are caused by ESBL-producing Enterobacteriaceae, which are more likely to result in death compared to the infections caused by a non ESBL-producing strains [14]
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