Comparative Study on Antibiotic Resistance Profile of Extended-Spectrum Beta-Lactamase and Non-Extended-Spectrum Beta-Lactamase Escherichia coli Infections among Pediatric Population with Community-Acquired Urinary Tract Infections in a Tertiary Care Centre.

Introduction: Increasing the prevalence of antimicrobial resistance due to the production of extended-spectrum beta-lactamase (ESBL) among bacterial pathogens specifi cally Escherichia coli in community-acquired urinary tract infection (UTI) is a concern. Studies on ESBL E. coli in CA pediatric UTI are limited. Objectives: To compare antibiogram and thereby antibiotic resistance pattern between ESBL and non-ESBL E. coli isolates in children with CAUTI. Methods: Prospective study conducted from November 2012 to January 2015 in a tertiary care pediatric center. E. coli in urine cultures from children aged <= 18 years was identifi ed by standard biochemical reactions and antibiotic susceptibility tested by Kirby-Bauer disc diffusion. ESBL production was determined by double-disc diffusion method using ceftazidime (30 mcg) and ceftazidime-clavulanic acid (30 mcg/10 mcg) and confi rmed by E-test using triple ESBL detection kit. Antibiograms were compared for statistical signifi cance. Results: A total of 385 isolates with culture-proven E. coli CAUTI were included. Of these, 159 (41.3%) were ESBL positive. Overall, resistance to multiple classes of antibiotics were noted among E. coli isolates including ampicillin (69.9%), co-trimoxazole (56.9%), cefi xime (84.4%), ceftazidime (85.7%), ciprofl oxacin (60.5%), and gentamicin (31.7%). The association between ESBL production in E. coli and drug resistance was signifi cant for ceftazidime (0.000), cefi xime (P = 0.000), cefotaxime (P = 0.037), ceftazidime-clavulanic acid (P = 0.000), and levofl oxacin (P = 0.018). Conclusion: There is a need for continued monitoring of antimicrobial susceptibility of E. coli isolates in community-acquired pediatric UTI. ESBL confi rmatory tests should be part of routine antibiotic susceptibility testing, and ongoing local epidemiological surveillance is critical to monitor variability in resistance pattern.