Prevalence and Molecular characteristics of ESBL associated with the pediatric population in Qatar

Urinary tract infection (UTI) is one of the most common pediatric
infections and it may cause permanent kidney damage. The
β-lactam antibiotics have traditionally been the main treatment
for Enterobacteriaceae, nonetheless, the emergence of species
producing β- Lactamases has rendered this class of antibiotics
largely ineffective. There are no published data on UTI etiological
agents and antimicrobial resistance profile among children in Qatar.
The aim of this study is to identify the most common ESBL species
associated with UTIs, to determine the phenotypic profiles of
antimicrobial resistant Enterobacteriaceae and to characterize
at the molecular level the genes encoding resistance in ESBL
producing Enterobacteriaceae among pediatric patients in Qatar.
A total of 635 Enterobacteriaceae were isolated from 727 urine
cultures, collected between February and June 2017 from children
(0-15 years) diagnosed with UTI at Pediatric Emergency Center,
Doha, Qatar. Most of the UTI were reported among 0-5 years
old (73.6%) children. Initial screening with phoenix revealed 201
(31.7 %) as Extended Spectrum β -Lactamases (ESBL) producing
Enterobacteriaceae. The most predominant pathogen of these
was E. coli 166 (83%), followed by K. pneumoniae 22 (11%).
110 isolates were included for further analysis. ESBL resistance
was further confirmed by double disc synergy test and PCR. The
highest resistance was encoded by bla CTX-M (59%) genes,
primarily bla CTX-MG1 (89.2%), followed by bla CTX-MG9 (7.7%).
37% of bacteria were harboring multiple bla genes (2 genes or
more). Analyzed samples were categorized into seven clonal
clusters according to the presence and absence of seven genes.
In conclusion, our data designate a high occurrence of CTX-MG1
indicating a high dynamic transmit-ability in the community that
could have a significant impact on public health, mostly through
horizontal transmission in healthcare facilities. In addition, our
results indicate an escalated problem of ESBL in pediatrics with
UTI, which mandates the establishment of the antimicrobial
stewardship program. Moreover, our findings revealed that the use
of cephalosporins, gentamicin and trimethoprim/sulfamethoxazole
is compromised in Qatar among the pediatric population with UTI,
leaving carbapenems and amikacin as the therapeutic option for
severe infections caused by ESBL producers. The negative impact
of the extensive use of carpabenemes could lead to carbapenamase
resistant Enterobacteriaceae.