CC BY-NC-ND 4.0 · J Lab Physicians 2017; 9(03): 156-162
DOI: 10.4103/0974-2727.208262
Original Article

Antimicrobial susceptibility, risk factors and prevalence of bla cefotaximase, temoneira, and sulfhydryl variable genes among Escherichia coli in community-acquired pediatric urinary tract infection

Kallyadan V. Nisha
Department of Microbiology, Century International Institute of Dental Sciences and Research Centre, Kasaragod, Kerala, India
Shetty A. Veena
Department of Microbiology and Pediatrics, K.S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
Shenoy D. Rathika
Department of Microbiology and Pediatrics, K.S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
Shenoy M. Vijaya
Department of Microbiology and Pediatrics, K.S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
Shetty K. Avinash
Department of Pediatrics, School of Medicine, Wake Forest University, USA
› Author Affiliations
Financial support and sponsorship Nil.


INTRODUCTION: The emergence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has become an important challenge among pediatric patients with community-acquired urinary tract infection (UTI).

OBJECTIVES: The aim of this study was to assess the antimicrobial susceptibility patterns, associated risk factors and to survey the frequency of bla cefotaximase (CTX-M), bla temoneira (TEM), and bla sulfhydryl variable (SHV) genotypes in ESBL-producing E. coli isolated from children with community-acquired UTI.

METHODS: This was a prospective study conducted from November 2012 to March 2016 in a tertiary care center. E. coli isolated in urine cultures from children aged ≤18 years was identified and confirmed for ESBL production. ESBL-positive strains were screened for ESBL encoding genes. Chi-square test and Fisher’s exact test were used to compare the difference in antibiotic susceptibility with respect to ESBL positive and negative, and binary logistic regression was used to identify the risk factors associated with ESBL production.

RESULTS: Among 523 E. coli isolates, 196 (37.5%) were ESBL positive, >90% were resistant to cephalosporins, and 56% were resistant to fluoroquinolones. Least resistance was observed for imipenem, netilmicin, and nitrofurantoin (2%, 8.6%, 15.3%). Association between ESBL production and drug resistance was significant for ceftazidime (P < 0.001), cefixime (P < 0.001), cefotaxime (P = 0.010), ceftazidime-clavulanic acid (P < 0.001), levofloxacin (P = 0.037), and gentamicin (P = 0.047) compared to non-ESBL E. coli. CTX-M gene was the most prevalent (87.5%), followed by TEM (68.4%) and SHV (3.1%). Previous history of UTI and intake of antibiotics were the common risk factors.

CONCLUSION: ESBL-producing E. coli from community-acquired pediatric UTI carries more than one type of beta-lactamase coding genes correlating their increased antibiotic resistance. Aggressive infection control policy, routine screening for detecting ESBL isolates in clinical samples, and antimicrobial stewardship are the keys to prevent their dissemination in community settings.

Publication History

Received: 07 July 2016

Accepted: 04 January 2017

Article published online:
19 February 2020

© 2017.

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  • References

  • 1 Rodriguez-Bano J, Alcala JC, Cisneros JM, Grill F, Oliver A, Horcajada JP, et al. Community infections caused by extended-spectrum β-lactamase–producing Escherichia coli. Arch Intern Med 2008;68:1897-902.
  • 2 Feizabadi MM, Delfani S, Raji N, Majnooni A, Aligholi M, Shahcheraghi F, et al. Distribution of bla(TEM), bla(SHV), bla(CTX-M) genes among clinical isolates of Klebsiella pneumoniae at Labbafinejad Hospital, Tehran, Iran. Microb Drug Resist 2010;16:49-53.
  • 3 Akram M, Shahad M, Khan AU. Etiology and antibiotic resistance patterns of community acquired urinary tract infections in JNMC Hospital, Aligarh, India. Ann Clin Microbiol Antimicrob 2007;23:4-10.
  • 4 Sharma S, Kaur N, Malhotra S, Madan P, Ahmad W, Hans C. Serotyping and antimicrobial susceptibility pattern of Escherichia coli isolates from urinary tract infections in pediatric population in a tertiary care hospital. J Pathog 2016;2016:2548517.
  • 5 Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610.
  • 6 Ha YE, Kang CI, Joo EJ, Park SY, Kang SJ, Wi YM, et al. Clinical implications of healthcare-associated infection in patients with community-onset acute pyelonephritis. Scand J Infect Dis 2011;43:587-95.
  • 7 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Twenty-First Informational Supplement M100-S20. Vol. 30. Wayne, PA: CLSI; 2010. p. 46.
  • 8 Collee JG, Miles RS, Watt B. Tests for identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney Practical Medical Microbiology. 14th ed. Singapore: Churchill Livingstone; 2006. p. 131-49.
  • 9 Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966;45:493-6.
  • 10 Geser N, Stephan R, Kuhnert P, Zbinden R, Kaeppeli U, Cernela N, et al. Fecal carriage of extended-spectrum ß-lactamase-producing Enterobacteriaceae in swine and cattle at slaughter in Switzerland. J Food Prot 2011;74:446-9.
  • 11 Colomer-Lluch M, Jofre J, Muniesa M. Antibiotic resistance genes in the bacteriophage DNA fraction of environmental samples. PLoS One 2011;6:e17549.
  • 12 Jemima SA, Verghese S. Multiplex PCR for bla(CTX-M) & bla(SHV) in the extended spectrum beta lactamase (ESBL) producing gram-negative isolates. Indian J Med Res 2008;128:313-7.
  • 13 Kizilca O, Siraneci R, Yilmaz A, Hatipoglu N, Ozturk E, Kiyak A, et al. Risk factors for community-acquired urinary tract infection caused by ESBL-producing bacteria in children. Pediatr Int 2012;54:858-62.
  • 14 El-Kersh TA, Marie MA, Al-Sheikh YA, Al-Kahtani SA. Prevalence and risk factors of community-acquired urinary tract infections due to ESBL-producing gram negative bacteria in an Armed Forces Hospital in Sothern Saudi Arabia. Glob Adv Res J Med Sci 2015;4:321-30.
  • 15 Meier S, Weber R, Zbinden R, Ruef C, Hasse B. Extended-spectrum b-lactamase producing gram-negative pathogens in community-acquired urinary tract infections. An increasing challenge for antimicrobial therapy. Infection 2011;39:333-40.
  • 16 Colodner R, Rock W, Chazan B, Keller N, Guy N, Sakran W, et al. Risk factors for the development of extended-spectrum b-lactamase-producing bacteria in non-hospitalized patients. Eur J Clin Microbiol Infect Dis 2004;23:163-7.
  • 17 Sana T, Rami K, Racha B, Fouad D, Marcel A, Hassan M, et al. Detection of genes TEM, OXA, SHV and CTX-M in 73 clinical isolates of Escherichia coli producers of extended spectrum Beta-lactamases and determination of their susceptibility to antibiotics. Int Arab J Antimicrob Agent 2011;1:1-6.
  • 18 Rezai MS, Salehifar E, Rafiei A, Langaee T, Rafati M, Shafahi K, et al. Characterization of multidrug resistant extended-spectrum beta-lactamase-producing Escherichia coli among uropathogens of pediatrics in North of Iran. Biomed Res Int 2015;2015:309478.
  • 19 Omar BA, Alfadel OO, Atif HA, Mogahid ME. Prevalence of TEM, SHV and CTXM genes in Escherichia coli and Klebsiella spp urinary isolates from Sudan with confirmed ESBL phenotype. Life Sci J 2013;10:191-5.