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Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal
Ganendra Bhakta Raya1, Bhim Gopal Dhoubhadel2,3, Dhruba Shrestha1
1Siddhi Memorial Hospital, Bhaktapur, Nepal.
Insights
Multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing uropathogens are prevalent in children with urinary tract infections (UTI). Nitrofurantoin, ofloxacin, and amikacin show promise for empirical treatment.
Area of Science:
- Microbiology
- Pediatrics
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) in children can lead to severe complications if not treated promptly.
- The rise of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing uropathogens complicates pediatric UTI management.
- This study investigated the prevalence of these resistant uropathogens in children.
Purpose of the Study:
- To determine the prevalence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing uropathogens in pediatric urinary tract infections (UTIs).
Main Methods:
- Collected and analyzed 5545 midstream urine samples from children under 16 years.
- Identified uropathogens using standard culture and biochemical tests.
- Performed antimicrobial susceptibility testing following CLSI guidelines, including specific tests for ESBL production.
Main Results:
- Identified uropathogens in 3.7% of samples, with *Escherichia coli* and *Klebsiella pneumoniae* being most common.
- Found high resistance rates to amoxicillin (80.3%) and cotrimoxazole (51.2%).
- Detected MDR in 34.5% and ESBL producers in 24.6% of uropathogen isolates, with higher MDR rates in children under 5 years.
Conclusions:
- Nitrofurantoin, ofloxacin, and amikacin are potential options for empirical UTI treatment in children in the study area.
- The significant prevalence of MDR and ESBL-producing uropathogens necessitates ongoing antimicrobial resistance surveillance.
- Effective management of pediatric UTIs requires awareness of local resistance patterns.
Background:
The emergence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing uropathogens has complicated the treatment of urinary tract infections (UTI). Paediatric UTI is a common illness, which if not treated properly, may lead to acute and long-term complications, such as renal abscess, septicaemia, and renal scarring. This study aimed to determine the prevalence of MDR and ESBL-producing uropathogens among children.
Methods:
During the study period (April 2017-April 2018), midstream urine samples were collected following aseptic procedures from children < 16 years in Siddhi Memorial Hospital. Standard culture and biochemical tests were performed to identify uropathogens and antimicrobial susceptibility test was done by modified Kirby-Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL-producing uropathogens were screened by ceftazidime (30 μg) and cefotaxime (30 μg) discs, and confirmed by the combination disc tests: ceftazidime + clavulanic acid (30/10 μg) or cefotaxime + clavulanic acid (30/10 μg) as recommended by CLSI.
Results:
We processed 5545 non-repeated urine samples from the children with symptoms of UTI. A significant growth of uropathogens was observed in 203 samples (3.7%). The median age of the children was 24 months (interquartile range (IQR), 12-53 months). Escherichia coli (n = 158, 77.8%) and Klebsiella pneumoniae (n = 30, 14.8%) were common among the uropathogens. Among them, 80.3% were resistant to amoxycillin and 51.2% were resistant to cotrimoxazole. Most of them were susceptible to amikacin, nitrofurantoin, and ofloxacin. MDR was detected in 34.5% (n = 70/203) and ESBL producers in 24.6% (n = 50/203) of them. The proportion of MDR isolates was higher in children < 5 years (n = 59/153, 38.6%) than children ≥ 5 years (n = 11/50, 22%) (P = 0.03).
Conclusions:
Nitrofurantoin, ofloxacin, and amikacin can be used for the empirical treatment for UTI in children in Bhaktapur, Nepal. MDR and ESBL-producing uropathogens are prevalent; this warrants a continuous surveillance of antimicrobial resistance.
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