Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal

Raya, Ganendra Bhakta, Dhoubhadel, Bhim Gopal, Shrestha, Dhruba, Raya, Sunayana, Laghu, Ujjwal, Shah, Ashok, Raya, Bijendra Bhakta, Kafle, Rita, Parry, Christopher M ORCID: 0000-0001-7563-7282 and Ariyoshi, Koya (2020) Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal. TROPICAL MEDICINE AND HEALTH, 48 (1). 65-.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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). <i>Escherichia coli</i> (<i>n</i> = 158, 77.8%) and <i>Klebsiella pneumoniae</i> (<i>n</i> = 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% (<i>n</i> = 70/203) and ESBL producers in 24.6% (<i>n</i> = 50/203) of them. The proportion of MDR isolates was higher in children < 5 years (<i>n</i> = 59/153, 38.6%) than children ≥ 5 years (<i>n</i> = 11/50, 22%) (<i>P</i> = 0.03).<h4>Conclusions</h4>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.

Item Type:	Article
Uncontrolled Keywords:	Urinary tract infection, Multidrug-resistance, Extended-spectrum beta-lactamase, E, coli, K, pneumoniae, Children, Nepal
Depositing User:	Symplectic Admin
Date Deposited:	21 Sep 2020 08:58
Last Modified:	18 Jan 2023 23:32
DOI:	10.1186/s41182-020-00251-6
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3102031