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Transurethral Induction of Mouse Urinary Tract Infection
Published on: August 5, 2010
Molecular characterization of extended spectrum β -lactamases enterobacteriaceae causing lower urinary tract
Nahla O Eltai1, Asmaa A Al Thani1,2, Khalid Al-Ansari3
11Biomedical Research Center, Qatar University, P.O. Box 2713, Doha, Qatar.
Insights
Extended Spectrum Beta-Lactamases (ESBL) are a growing problem in pediatric urinary tract infections (UTIs) in Qatar. This study highlights the urgent need for control measures due to widespread resistance, impacting common antibiotic choices.
Area of Science:
- Microbiology
- Infectious Diseases
- Molecular Biology
Background:
- Beta-lactam antibiotics are standard for Enterobacteriaceae infections but are failing due to emerging beta-lactamase enzymes.
- Data on pediatric urinary tract infection (UTI) etiology and antimicrobial resistance in Qatar is lacking.
- This study addresses the need to understand antimicrobial resistance in pediatric UTIs in Qatar.
Purpose of the Study:
- To determine the phenotypic and genotypic profiles of antimicrobial-resistant Enterobacteriaceae in children with UTIs in Qatar.
- To investigate the prevalence and characteristics of Extended Spectrum Beta-Lactamases (ESBL) producing Enterobacteriaceae in pediatric UTIs.
- To provide data on antimicrobial resistance patterns to guide clinical practice in Qatar.
Main Methods:
- Isolated bacteria from 727 pediatric UTI urine cultures (February-June 2017).
- Antibiotic susceptibility testing against 16 antibiotics using Phoenix and Double Disc Synergy Test (DDST) for ESBL confirmation.
- Polymerase chain reaction (PCR) used to identify ESBL resistance genes.
Main Results:
- 31.7% of isolates were ESBL-producing Enterobacteriaceae, with E. coli (83%) and K. pneumoniae (11%) being dominant.
- CTX-M genes, particularly CTX-M-G1 (89.2%), were the most common resistance mechanism (59%).
- 37% of isolates harbored multiple resistance genes; E. coli and K. pneumoniae showed distinct clonal clustering.
Conclusions:
- An escalating problem of ESBL-producing Enterobacteriaceae in pediatric UTIs in Qatar necessitates regulatory control programs.
- Common antibiotics like cephalosporins, gentamicin, and trimethoprim/sulfamethoxazole are compromised for pediatric UTIs in Qatar.
- Carbapenems and amikacin remain viable therapeutic options for severe infections caused by ESBL producers in this population.
Background:
The 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.
Methods:
Bacteria 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.
Results:
201 (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 CTX-M (59%) genes, primarily CTX-MG1 (89.2%) followed by CTX-MG9 (7.7%). 37% of isolated bacteria were harboring multiple 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 TEM, SHV, CTX-MG1, CTX-MG2, CTX-MG8 bla CTX-MG9, CTX-MG25.
Conclusions:
Our 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.
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