Pediatric Infectious Disease

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VOLUME 4 , ISSUE 4 ( October-December, 2022 ) > List of Articles

Original Article

Evaluation of clinical Spectrum, antibiotic Sensitivity, and clinical Outcome in pediatric Age Group (0–18 Years) with Extended-spectrum Beta-lactamase-producing Escherichia coli-associated Urinary Tract Infection in Tertiary Care Hospital in India

Keyur D Mahajan, Rajan Joshi

Keywords : Antimicrobial resistance, Extended-spectrum beta-lactamase-producing Escherichia coli, Urinary tract infections in the pediatric population

Citation Information : Mahajan KD, Joshi R. Evaluation of clinical Spectrum, antibiotic Sensitivity, and clinical Outcome in pediatric Age Group (0–18 Years) with Extended-spectrum Beta-lactamase-producing Escherichia coli-associated Urinary Tract Infection in Tertiary Care Hospital in India. Pediatr Inf Dis 2022; 4 (4):133-137.

DOI: 10.5005/jp-journals-10081-1366

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: There is an increasing prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli-associated urinary tract infections (UTIs) in the pediatric population. These multidrug infections are challenging to treat. Objectives: Our aim is to study the clinical profile in children having urine culture positive with ESBL E. coli, antibiotic sensitivity pattern for ESBL E. coli in urine cultures, and evaluate clinical outcomes in patients with ESBL E. coli-associated UTI in our hospital. Methods: We collected reports of all urine cultures for age group 0–18 years with colony counts >105 CFU/mL during the study period from January 2017 to December 2021 done in our hospital pathology lab. All urine culture positive reports were separated according to causative organism. From this, the subgroup of patients with ESBL E. coli was our study's focus. The prevalence of ESBL E. coli as a causative organism was calculated. These patients were further analyzed for clinical spectrum, antibiotic sensitivity pattern, and clinical outcome. Results: Out of 450 urine culture positive reports during the study period, E. coli was the most common organism with 259 (57%) cases. The maximum incidence of ESBL E. coli-associated urinary infection was in patients between 0 and 5 years (56%). The prevalence of infection in females (59%) was slightly higher than in males (41%). Extended-spectrum beta-lactamase E. coli are highly sensitive to the carbapenem group of antibiotics, amikacin, and fosfomycin. Resistance was 100% for ampicillin, aztreonam, ceftriaxone, and cefixime. Other antibiotics with high resistance were trimethoprim/sulfamethoxazole and the fluoroquinolone group of antibiotics. About 25% of children had h/o previous episodes of UTI. About 43% of patients had some significant underlying medical problem. About 51% of indoor patient department (IPD) patients had normal ultrasonogram (USG) or no findings related to the renal system. Each IPD patient was treated with antibiotics (IV plus oral) for 11 days on average. There were differences between in vitro antibiotic sensitivity and clinical experience for a few cephalosporin antibiotics. Overall mortality among IPD patients was 4%. Conclusions: Girls have more chances of getting UTIs due to ESBL E. coli than boys. Incidence of UTI due to ESBL E. coli is more during 0–5 years of life than in older children. Urinary tract infection due to ESBL E. coli is associated with high mortality. Carbapenems, amikacin, and fosfomycin are good choices of antibiotics to treat such infections. Antibiotic sensitivity patterns for cephalosporins derived by currently available methods do not always match clinical experience.


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  1. Shaikh N, Morone NE, Bost JE, et al. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Disease J 2008;27(4):302–308. DOI: 10.1097/INF.0b013e31815e4122
  2. Desai DJ, Gilbert B, McBride CA. Paediatric urinary tract infections: diagnosis and treatment. Aust Fam Physician 2016;45(8):558–563.
  3. Moore CE, Sona S, Poda S, et al. Antimicrobial susceptibility of uropathogens isolated from Cambodian children. Paediatr Int Child Health 2016;36(2):113–117. DOI: 10.1179/2046905515y.0000000008
  4. Kizilca O, Siraneci R, Yilmaz A, et al. Risk factors for community-acquired urinary tract infection caused by ESBL-producing bacteria in children. Pediatr Int 2012;54(6):858–862. DOI: 10.1111/j.1442-200x.2012.03709.x
  5. Pourakbari B, Ferdosian F, Mahmoudi S, et al. Increase resistant rates and ESBL production between E. coli isolates causing urinary tract infection in young patients from Iran. Braz J Microbiol 2012;43(2):766–769. DOI: 10.1590/S1517-83822012000200041
  6. Rezai MS, Salehifar E, Rafiei A, et al. Characterisation of multidrug resistant extended-spectrum beta-lactamase-producing Escherichia coli among uropathogens of pediatrics in north of Iran. Biomed Res Int 2015;2015:309478. DOI: 10.1155/2015/309478
  7. Awean GZA, Salameh K, Elmohamed H, et al. Prevalence of ESBL urinary tract infection in children. J Adv Pediatr Child Health 2019;2:004–007. DOI: 10.29328/journal.japch.1001004
  8. Shettigar SCG, Roche R, Nayak N, et al. Bacteriological profile, antibiotic sensitivity pattern, and detection of extended-spectrum β-lactamase in the isolates of urinary tract infection from children. J Child Health 2016;3:5. DOI: 10.32677/IJCH.2016.v03.i01.006
  9. European Centre for Disease Prevention and Control. Summary of the Latest Data on Antibiotic Resistance in the European Union. Stockholm: ECDC; 2016.
  10. Peco-Antić A, Paripović D, Buljugić S, et al. In vivo susceptibility of ESBL producing Escherichia coli to ceftriaxone in children with acute pyelonephritis. Srp Arh Celok Lek 2012;140(5-6):321–325. DOI: 10.2298/sarh1206321p. PMID: 22826985.
  11. Anderson DT, Albrecht B, Jones KA, et al. Efficacy of noncarbapenem β-lactams compared to carbapenems for extended-spectrum β-lactamase-producing enterobacterales urinary tract infections. Open Forum Infect Dis 2022;9(3):ofac034. DOI: 10.1093/ofid/ofac034
  12. Ekambaram S, Jahan A, Sathe KP. Standard Treatment Guidelines, 2022, for Urinary Tract Infection in Children. Indian Academy of Pediatrics.
  13. Indian Society of Pediatric Nephrology, Vijayakumar M, Kanitkar M, et al. Revised statement on management of urinary tract infections. Indian Pediatr 2011;48(9):709–717.
  14. BD Phoenix™ M50 Automated Microbiology System.www.bd.com
  15. Colodner R, Rock W, Chazan B, et al. Risk factors for the development of extended-spectrum beta-lactamase-producing bacteria in nonhospitalized patients. Eur J Clin Microbiol Infect Dis 2004;23(3):163–167. DOI: 10.1007/s10096-003-1084-2
  16. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. Nineteenth Informational Supplement. CLSI Document M100-S19. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.
  17. Albaramki JH, Abdelghani T, Dalaeen A, et al. Urinary tract infection caused by extended-spectrum β-lactamase-producing bacteria: risk factors and antibiotic resistance. Pediatr Int 2019;61(11):1127–1132. DOI: 10.1111/ped.13911
  18. Sharma S, Kaur N, Malhotra S, et al. Serotyping and antimicrobial susceptibility pattern of Escherichia coli isolates from urinary tract infections in pediatric population in a tertiary care hospital. J Pathog 2016;2016:2548517. DOI: 10.1155/2016/2548517
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