Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal
Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal
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DOI：
10.1186/s41182-020-00251-6
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发表时间：
2020-08-03
影响因子：
4.5
通讯作者：
Ariyoshi, Koya
中科院分区：
文献类型：
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作者：
Raya, Ganendra Bhakta;Dhoubhadel, Bhim Gopal;Ariyoshi, Koya
背景多药耐药(MDR)和产超广谱β-内酰胺酶(ESBL)尿路病原菌的出现使尿路感染(UTI)的治疗复杂化。儿科尿路感染是一种常见疾病，如果治疗不当，可能会导致急性和长期的并发症，如肾脓肿、败血症和肾疤痕形成。本研究旨在确定儿童中耐多药和产超广谱β-内酰胺酶的尿路病原菌的流行情况。方法在研究期间(2017年4月至2018年4月)，收集锡地纪念医院16岁儿童无菌操作后的中段尿样。采用标准培养和生化试验进行病原菌鉴定，药敏试验采用改良的Kirby-Bauer纸片扩散法，药敏试验采用美国临床与实验室标准协会(CLSI)指南。用头孢他啶(30mU/g)和头孢噻肟(30mU/g)纸片筛选产超广谱β-内酰胺酶(ESBL)，并按CLSI推荐的头孢他啶+克拉维酸(30/10mU/g)或头孢他啶+克拉维酸(30/10mU/g)进行联合纸片试验。结果共处理尿路感染患儿无重复尿液标本5545份。203例(3.7%)尿路病原菌明显增多。儿童的平均年龄为24个月(四分位数范围)，12-53个月，其中大肠埃希菌158例，占77.8%，肺炎克雷伯菌30例，占14.8%。其中80.3%对阿莫西林耐药，51.2%对复方新诺明耐药。多数对阿米卡星、呋喃妥因、氧氟沙星敏感。耐多药菌株占34.5%(70/203)，产超广谱β-内酰胺酶菌株占24.6%(50/203)。5岁以下儿童(n=59/153，38.6%)的耐多药菌株比例高于5岁以下儿童(11/50，22%)(P=0.03)。结论硝基呋喃妥因、氧氟沙星和阿米卡星可用于尼泊尔巴克塔普尔地区儿童尿路感染的经验性治疗。耐多药和产超广谱β-内酰胺酶的尿路病原菌很普遍；这需要持续监测抗菌素耐药性。
Background 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. Methods 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 mu g) and cefotaxime (30 mu g) discs, and confirmed by the combination disc tests: ceftazidime + clavulanic acid (30/10 mu g) or cefotaxime + clavulanic acid (30/10 mu g) as recommended by CLSI. Results 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).Escherichia coli(n= 158, 77.8%) andKlebsiella pneumoniae(n= 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% (n= 70/203) and ESBL producers in 24.6% (n= 50/203) of them. The proportion of MDR isolates was higher in children < 5 years (n= 59/153, 38.6%) than children >= 5 years (n= 11/50, 22%) (P= 0.03). Conclusions 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.