Characterization of Extended Spectrum Beta-lactamase and Carbapenamase Producing Enterobacteriaceae Causing Urinary Tract Infection among Children in Kenya: A Cross-Sectional Study
Introduction: Enterobacteriaceae causing urinary tract infections (UTI) have developed resistance to the commonly used antibiotics due to emergence of Extended Spectrum Beta-Lactamases (ESBLs) and Carbapenamase producing Enterobactericeae which are a public health problem worldwide. This study aims to determine the prevalence and characterize ESBLs and carbapenamase producing Enterobactericeae. Method: A cross-sectional study was carried out in Gertrude’s Children’s Hospital, Nairobi. 238 urine samples were collected from patients with urinary symptoms attending the outpatient department within the period 2020-2021. The urine were examined macroscopically and microscopically. Identification and antimicrobial susceptibility testing were done using VITEK？ 2 Compact system (BioMérieux). Double disc synergy test and modified hodge tests were done as confirmatory tests for ESBLs and Carbapenamase phenotypes respectively. Polymerase Chain Reaction was used for the detection of blaCTX-M, blaTEM, blaSHV, blaKPC and blaOXA-48 genes. Results: From the 238 children sampled the prevalence of UTI caused by Enterobactericeae was 22.3%. The Enterobacteriaceae species isolated were Escherichia coli (84.9%), Klebsiella pneumoniae (5.66%), Proteus mirabillis (5.66%), Enterobacter aerogenes (1.89%)and Morganella morganii (1.89%). The isolated species were resistant to ampicillin. Meropenem had the highest susceptibility. Only E. coli species had the ESBLs (26.4%) and carbapenamase (1.9%) phenotypes. 100% had BlaCTX-M while 50% had blaTEM resistant gene. There was a significant association (p < 0.05) between non-school going children and ESBLs related urinary tract infection. A significant association (p < 0.001) was also seen between presence of red blood cells in urine and ESBL UTI. Conclusion:Ampicillin resistanceresulted to use of alternative drugs and Meropenem was the drug of choice where increased resistance to the recommended drugs was noted. Further research on resistant genes is recommended.
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