Infection and drug resistance · 2026
Prevalence and Antibiotic Resistance Pattern of Escherichia coli Isolated from Urine Samples of Pediatric Outpatients with Underlying Medical Conditions from Pakistan.
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Khan Muhammad Nadeem, Haroon Atif, Bilal Hazrat
Аннотация
BACKGROUND: Urinary tract infections (UTIs) caused by Escherichia coli pose a significant health burden in children, particularly in those with underlying medical conditions. The emergence of antimicrobial resistance, including extended-spectrum β-lactamase (ESBL) production and multidrug resistance (MDR), complicates treatment strategies. Data on resistance patterns in this vulnerable population remain limited in low-income and middle-income countries.
METHODS: To determine the prevalence and antibiotic resistance patterns of E. coli isolated from urine samples of pediatric outpatients (1-12 years old) with underlying medical conditions. This hospital-based cross-sectional study was conducted at the Pakistan Institute of Medical Sciences (January 2022-January 2023). Urine samples were collected from 941 pediatric outpatients with documented underlying conditions. E. coli were identified biochemically and molecularly. Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion, with ESBL screening and confirmation.
RESULTS: E. coli was detected in 30.08% (283/941) of samples, which was significantly higher in females than in males (38.1%, p <0.001). ESBL production was detected in 30.4% (86/283) of the isolates and MDR isolates in 18.7% (53/283). The highest rates of resistance were observed against ampicillin (70.3%), cephalexin (60.1%), and trimethoprim-sulfamethoxazole (59.4%). Low resistance was noted to nitrofurantoin (2.8%) and amikacin (1.8%). Age was a significant predictor, with 1-year old children showing 2.1-fold 95% CI: 1.01-4.55) and 3.6‑fold (95% CI: 1.60-8.15) increased odds of ESBL production and MDR, respectively, compared to children aged 6-12 years.
CONCLUSION: High rates of ESBL-producing and MDR E. coli in Pakistani children with underlying conditions underscore the critical need for antimicrobial stewardship and empirical therapy guided by local susceptibility patterns, particularly in younger children.
METHODS: To determine the prevalence and antibiotic resistance patterns of E. coli isolated from urine samples of pediatric outpatients (1-12 years old) with underlying medical conditions. This hospital-based cross-sectional study was conducted at the Pakistan Institute of Medical Sciences (January 2022-January 2023). Urine samples were collected from 941 pediatric outpatients with documented underlying conditions. E. coli were identified biochemically and molecularly. Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion, with ESBL screening and confirmation.
RESULTS: E. coli was detected in 30.08% (283/941) of samples, which was significantly higher in females than in males (38.1%, p <0.001). ESBL production was detected in 30.4% (86/283) of the isolates and MDR isolates in 18.7% (53/283). The highest rates of resistance were observed against ampicillin (70.3%), cephalexin (60.1%), and trimethoprim-sulfamethoxazole (59.4%). Low resistance was noted to nitrofurantoin (2.8%) and amikacin (1.8%). Age was a significant predictor, with 1-year old children showing 2.1-fold 95% CI: 1.01-4.55) and 3.6‑fold (95% CI: 1.60-8.15) increased odds of ESBL production and MDR, respectively, compared to children aged 6-12 years.
CONCLUSION: High rates of ESBL-producing and MDR E. coli in Pakistani children with underlying conditions underscore the critical need for antimicrobial stewardship and empirical therapy guided by local susceptibility patterns, particularly in younger children.