Frequency and Antimicrobial Susceptibility Patterns of ESBL-Producing Uropathogens in Culture-Confirmed Pediatric Urinary Tract Infections
Keywords:
Antibiotic Resistance, Child, Enterobacteriaceae, Escherichia Coli, Klebsiella Pneumoniae, Urinary Tract Infection.Abstract
Objective: To determine the frequency of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae isolated from culture-confirmed pediatric urinary tract infections and to evaluate their antimicrobial susceptibility patterns according to age and sex.
Study Design: Analytical cross-sectional study employing consecutive sampling.
Place and Duration of Study: Holy Family Hospital, Department of Pediatrics from 1st April 2023 to 1st April 2024.
Materials and Methods: Children aged 1 month to 12 years with clinical features of urinary tract infection and a positive urine culture were recruited. Urine specimens were processed for bacterial identification, antimicrobial susceptibility testing and confirmation of ESBL production. Age, sex, isolated organism, ESBL status and antimicrobial susceptibility findings were recorded and analyzed.
Results: Among 384 children, 236 (61.5%) were female and 148 (38.5%) were male. Escherichia Coli was the most frequently isolated organism, accounting for 284 (74.0%) cases, followed by Klebsiella Pneumoniae in 62 (16.1%) cases. Of 346 Enterobacteriaceae isolates, 208 (60.1%) produced ESBL. ESBL production was detected in 162 (57.0%) Escherichia coli isolates and 46 (74.2%) Klebsiella pneumoniae isolates. Infections were more frequent among children aged 1 month to <5 years and among females. Resistance was highest to ampicillin,
co-amoxiclav and ciprofloxacin, whereas meropenem and fosfomycin retained complete antimicrobial activity.
Conclusion: Extended-spectrum beta-lactamase producing Enterobacteriaceae were common among children with urinary tract infections, particularly in younger children and females. The high resistance to commonly prescribed antibiotics supports regular antimicrobial surveillance and culture guided treatment. Routine urine culture and antimicrobial susceptibility testing should be encouraged before initiation of definitive therapy to
optimize antibiotic stewardship.
