Isolation of extended spectrum beta-lactamase producing Enterobacteriaceae among children with urinary tract infection: A cross sectional study.

Abstract

<title>Abstract</title> Background: Resistance of Gram-negative bacteria to antibiotics had increased at an alarming pace over the last two decades. Empirical antibiotic treatment of UTI practice created opportunity for frequent use of antibiotics that resulted in emergence of resistant strains. Extended spectrum beta-lactamase producing <italic>Enterobacteriaceae </italic>are emerging worldwide and are usually multi-drug resistant; thus, limiting treatment options for these organisms. Hence, it is mandatory to scrutinize the extent of the problem in the study area. Objective: We investigated the prevalence and correlates of extended spectrum beta-lactamase producing <italic>Enterobacteriaceae </italic>and their antibacterial resistance profile among children with urinary tract infection (UTI) at Hawassa University Comprehensive Specialized Hospital. Method: A hospital-based cross sectional study was conducted from February 1-July 30/ 2018. A semi-structured questionnaire was used to collect data from 284 children suspected of UTI. Bacterial species were isolated using standard bacteriological techniques. Antibiotic susceptibility testing was done using Kirby-Bauer disk diffusion method and ESBL production was detected by double disc synergy test. Data entry, cleaning and statistical analysis was done using SPSS version 20. Results: Overall, <italic>Enterobacteriaceae </italic>accounted for 75% (72/96) of UTI infections. The most frequent <italic>Enterobacteriaceae </italic>were <italic>E. coli</italic> , 44.4% (32/72) and K. pneumoniae , 27.8% (20/72). Overall, ESBL-producers within <italic>Enterobacteriaceae </italic>accounted for 41.7% (30/72) and magnitude of multi-drug resistance level was 86.1% (62/72). ESBL producing K. pneumoniae and <italic>E. coli</italic> accounted for 70% (14/20) and 37.5% (12/32), respectively of all the respective isolates. Previous UTI within the past 12 month (AOR= 0.08, 95% CI (0.01-0.57) and medium family wealth index (AOR = 0.03, 95% CI (0.00-0.27) were associated with infection of ESBL-producing <italic>Enterobacteriaceae </italic>. Conclusion: ESBL producing <italic>Enterobacteriaceae </italic>were prevalent among UTI cases; where <italic>E. coli </italic>and <italic>K. pneumoniae</italic> were the major isolated resistant strains that contributed mainly to the problem. Majority of Enterobacteriaceae isolated were resistant to commonly prescribed drugs. Key words : ESBL, Antimicrobial Resistance, UTI, Children.