Antimicrobial susceptibility of uropathogens isolated from Cambodian children

Abstract

Background: Bacterial resistance to commonly used antimicrobials is an increasing problem in Asia but information concerning the antimicrobial susceptibility of bacteria causing urinary tract infections (UTIs) in children is limited. Methods: This was a 5-year retrospective study of children with suspected UTI attending a paediatric hospital in north-west Cambodia. Urines with a positive culture containing a single organism with a count of w10 5 colony-forming units (CFU)/ml were considered diagnostic of infection. The organism was identified and the resistance pattern (using CLSI guidelines) and presence of an extended-spectrum b-lactamase (ESBL) phenotype was determined. Results: In total, there were 217 episodes of infection, 210 (97%) with Gram-negative bacteria. Escherichia coli was the most common infecting isolate with high levels of resistance to most oral antibiotics, except nitrofurantoin. Nearly half of the E. coli (44%) were extended-spectrum cephalosporin (ESC)-resistant with the proportion increasing significantly over the 5-year period. ESC-resistant E. coli were more likely to be multi-drug-resistant and 91% demonstrated an ESBL phenotype. Conclusion: The data highlight the importance of microbiological surveillance of UTIs in children, particularly in areas where there are known to be multiply resistant organisms.

Prevalence of ESBL urinary tract infection in children

“…In our study, the overall prevalence of ESBL-producing pathogens is 26.8 %, and the most common causative organisms were E.coli (66.93%), (32.4%), were ESBL, and Klebsiella Species (9.84%), (32%) were ESBL. This is comparable to other countries with prevalence in India of 37.7% [13], Iran 30.5% [14,15], Cambodia 44% [16], and Turkey 41% [17].…”

Carriage of carbapenemase‐ and extended‐spectrum cephalosporinase‐producing Escherichia coli and Klebsiella pneumoniae in humans and livestock in rural Cambodia; gender and age differences and detection of blaOXA‐48 in humans

“…To date, there are no published reports of CPE/K in humans or livestock in Cambodia or of community carriage of ESCE/K in Cambodia. However, ESCE/K isolates have been detected as causative pathogens in Cambodian patients (Caron et al, ; Emary et al, ; Moore et al, ; Rammaert et al, ; Vlieghe et al, ). Genetic characterization of ESBL‐producing E. coli isolates in bloodstream infections in Cambodia revealed that 96% were of CTX‐M‐type, mainly bla CTX‐M‐15 and bla CTX‐M‐14 (Vlieghe et al, ).…”

Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection

“…There is growing concern, however, about the antibiotic resistance of uropathogens due to improper and extensive use of antibiotics. Resistance to trimethoprim‐sulfamethoxazole (TMP‐SMX) and cephalosporins, which are primarily preferred in empiric treatment, is rapidly increasing . It is also of concern that the prevalence of UTI with extended spectrum beta‐lactamase‐producing (ESBL (+)) enteric bacteria also has been increasing worldwide .…”