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Pediatric Febrile Urinary Tract Infection Caused by ESBL Producing Enterobacteriaceae Species
Asnakech Agegnehu1, Mesfin Worku2, Demiss Nigussie3
1Microbiology Laboratory, Hawassa University Comprehensive Specialized Hospital, Ethiopia.
Insights
Extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae are a growing concern in pediatric urinary tract infections (UTIs). This study highlights high multidrug resistance and calls for routine ESBL testing and antimicrobial stewardship.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pediatrics
Background:
- Antibiotic resistance in uropathogens, particularly extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, is a significant challenge in treating pediatric urinary tract infections (UTIs).
- The increasing prevalence of ESBL-producing Enterobacteriaceae limits therapeutic options for children with febrile UTIs.
Purpose of the Study:
- To investigate the prevalence and associated factors of ESBL-producing Enterobacteriaceae in pediatric UTIs.
- To determine the antibiotic resistance patterns among these pathogens.
Main Methods:
- Collected 284 midstream urine samples from children with suspected UTIs.
- Performed urine culture, bacteria isolation, and antibiotic susceptibility testing using Kirby-Bauer disk diffusion.
- Identified ESBL production using the double-disc synergy test.
Main Results:
- UTI was confirmed in 33.8% of cases, with Enterobacteriaceae being the primary cause (75%).
- Escherichia coli and Klebsiella pneumoniae were the most common Enterobacteriaceae species.
- A high multidrug resistance rate of 86.1% was observed. ESBL producers constituted 41.7% of Enterobacteriaceae isolates, notably higher in K. pneumoniae (70%) and E. coli (37.5%).
Conclusions:
- ESBL production is prevalent in pediatric UTIs, particularly in K. pneumoniae, contributing significantly to drug resistance.
- Routine ESBL testing is recommended for clinical practice.
- Alarming resistance levels necessitate strengthened antimicrobial stewardship programs.
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.
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