Abstract
Background Over the past decade, drug resistance pattern has worsened for many of the uropathogens due to overuse of antibiotics for empiric treatment. The burden of extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae associated urinary tract infections (UTI) has become increasingly more common, limiting treatment options among children presenting with febrile UTI. We investigated the burden and correlates of ESBL producing Enterobacteriaceae associated UTI among children and antibacterial resistance pattern. Methods 284 midstream urine specimens were collected using standard aseptic techniques from 284 children who were diagnosed with suspected UTI. Urine culture and bacteria isolation were performed following standard bacteriological techniques. The Kirby-Bauer disk diffusion technique and the double-disc synergy test were used to investigate antibiotic susceptibility and presence of ESBL production. Results UTI was confirmed using a positive urine culture for a relevant pathogen in 96/284 (33.8%) of the cases. Enterobacteriaceae accounted for 75% (72/96) of etiologies of UTI in children. The most frequent Enterobacteriaceae spp. were E. coli, 44.4% (32/72) and K. pneumonia, 27.8% (20/72). The overall multidrug resistance rate was 86.1% (62/72). ESBL-producers accounted for 41.7% (30/72) of the isolated Enterobacteriaceae. ESBL producing K. pneumonia and E. coli isolates accounted for 70% (14/20) and 37.5% (12/32), respectively. History of UTI in the past 1 year (adjusted odds ratio (AoR) = 0.08, 95%CI (0.01 − 0.57)) and medium family wealth index (AoR = 0.03, 95%CI (0.00 − 0.27)) protected from infection with ESBL-producing Enterobacteriaceae. Conclusion. ESBL production was more common in K. pneumonia and appeared to be a major factor contributing drug resistance UTI in children. The findings call for the need to incorporate ESBL testing in the routine clinical practice. The resistance level to commonly prescribed first-line antibiotics observed within Enterobacteriaceae was alarming calling for strengthened antimicrobial stewardship.
Highlights
Urinary tract infection (UTI), which is commonly caused by Enterobacteriaceae like Escherichia coli (E. coli) and Klebsiella species and other Gram-negative bacteria, is one of the commonest causes of febrile illnesses in children [1, 2]
Extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae causing urinary tract infections (UTI) have been associated with prescription of broad-spectrum antibiotics, which further exacerbate the challenge of antimicrobial resistance (AMR) [3]
Our findings show that urine culture growth was observed in a third of cases presenting with clinically suspected cases of UTI
Summary
Urinary tract infection (UTI), which is commonly caused by Enterobacteriaceae like Escherichia coli (E. coli) and Klebsiella species and other Gram-negative bacteria, is one of the commonest causes of febrile illnesses in children [1, 2]. Extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae causing UTI have been associated with prescription of broad-spectrum antibiotics, which further exacerbate the challenge of antimicrobial resistance (AMR) [3]. Cephamycin groups including cefoxitin and cefotetan and carbapenems including imipenem, meropenem, and ertapenem are not hydrolyzed by ESBLs and are considered as the drugs of choice for treating ESBLproducing Enterobacteriaceae [8]. The burden of extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae associated urinary tract infections (UTI) has become increasingly more common, limiting treatment options among children presenting with febrile UTI. We investigated the burden and correlates of ESBL producing Enterobacteriaceae associated UTI among children and antibacterial resistance pattern. ESBL production was more common in K. pneumonia and appeared to be a major factor contributing drug resistance UTI in children. The resistance level to commonly prescribed first-line antibiotics observed within Enterobacteriaceae was alarming calling for strengthened antimicrobial stewardship
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
