Introduction: Urinary tract infection is among the most common causes of febrile illness in children. It can lead to complications including septicaemia, if appropriate therapy is not given. Drug resistance has emerged as a significant problem in treating UTI. Knowing the pattern of antimicrobial resistance will help the clinicians in prescribing antibiotics.

Aims and Objectives: To determine the proportion of multidrug resistant Gram negative bacilli causing urinary tract infection in paediatric age group, antibiotic susceptibility pattern and detection of genes conferring resistance.

Materials and Methods: This is a descriptive study in which a total of 480 Gram negative urinary isolates from children less than 12 years over a period of 1 year were included. Multidrug resistant isolates were subjected to phenotypic confirmatory tests for ESBL, MBL, AmpC. 104 randomly selected isolates were subjected to PCR for CTX, TEM, SHV and VIM genes.

Results: Majority of isolates were from males.72.9% of isolates were multidrug resistant. Majority of the isolates were E coli followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Proteus mirabilis, Klebsiella oxytoca, Proteus vulgaris and Citrobacter freundii. Acinetobacter baumannii had the largest number (76.9%) of multidrug resistant isolates. 47.2% of the MDR isolates were ESBL producers, 11.6% were AmpC producers  and 11.2 % were MBL producers. 85 % of the  ESBL producing isolates tested had CTX M gene and 22 % had TEM gene. 1 out of the 4 MBL producing Pseudomonas aeruginosa isolates tested had VIM gene.

Conclusion: The study emphasize the need for surveillance and development of local and paediatric specific antibiograms to reduce the growing resistance rates.

Keywords: ESBL, MBL, paediatric UTI, TEM, CTX- M.

1. Goel S, Mukherjee SB. Urinary Tract Infection – A Tale of 50 Years. Indian Pediatr 2016;(53):57–8.
2. Collee G, Duguid P, Fraser G, Marmian P. Mackey and MacCartney’s Practical Medical Microbiology. 14th ed. Vol. 2. Churchill Livingstone Publishers. Longman Singapore. 2003.
3. CLSI Performance standards for Antimicrobial Susceptibility testing, 27^th Informational supplement,CLSI document M100 S-27,Vol 36.Wayne , P A : Clinical and Laboratory Standards Institute , 2016
4. Coudron PE. Inhibitor-Based Methods for Detection of Plasmid-Mediated AmpC β-Lactamases in Klebsiella , Escherichia coli, and Proteus mirabilis. J Clin Microbiol. 2005 Aug;43(8):4163–7.
5. Conceição T, Brízio A, Duarte A, Lito LM, Cristino JM, Salgado MJ. First Description of CTX-M-15-Producing Klebsiella pneumoniae in Portugal. Antimicrob Agents Chemother. 2005 Jan;49(1):477–8.
6. Vacheva-Dobrevsky R, Jacoby GA. Epidemiology of Extended-Spectrum β-Lactamases in Sofia, Bulgaria. Eur J Clin Microbiol Infect Dis. 2003 Jun;22(6):385–8.
7. Fallah F, Borhan RS, Hashemi A. Detection of bla(IMP) and bla(VIM) metallo-β-lactamases genes among Pseudomonas aeruginosa Int J Burns Trauma. 2013 Apr 18;3(2):122–4.
8. Krishnan C, Gireeshan VK, Nimmi JE, Sabitha S, Vimalraj NA, Biju G. Clinico-bacteriological profile of urinary tract infections in children and resistance pattern of uropathogens- a study from south india. J Evid Based Med Healthc. 2017 Feb 1;4(15):859–63.
9. Taneja, N. Chatterjee, SS. Singh, M. Singh, S. and Sharma, M. 2010. Pediatric urinary tract infections in a tertiary care center from northern India. J. Med. Res. 131: 101-105.
10. Nagaraj S, Kalal B, Kamath N, Muralidharan S. Microbiological And Antimicrobial Profile Of Pathogens Associated With Pediatric Urinary Tract Infection: A One Year Retrospective Study From A Tertiary Care Teaching Hospital. National Journal of        Laboratory Medicine. 2014 Mar, Vol 3(1): 4-7
11. Nisha KV, Shenoy RD, Shetty AV, Shenoy VM and Shetty AK. Trends in antimicrobial resistance among uropathogens with special reference to coli in community acquired pediatric urinary tract infections from Kerala. J Evol Medical and Dental Sci. 2015;4(54):9313-20
12. Jitendranath A, Radhika R, Bhargavi L, Bhai G, Beevi R. Microbiological Profile of Urinary Tract Infection in Pediatric Population from a Tertiary Care Hospital in South Kerala. Journal of Bacteriology & Mycology: Open Access. 2015; 1(1):1-5.. 2013
13. Madhavan A, Jayalakshmi V. Occurrence of extended-spectrum beta-lactamase, AmpC and MBLase producers among multidrug-resistant Enterobacteriaceae causing urinary tract infection in a tertiary health-care teaching hospital. J Acad Clin Microbiol. 2016;18(2):80–5.
14. Sharma M, Yadav S, Chaudhary U. Metallo-beta-lactamase Producing Pseudomonas aeruginosa in Neonatal Septicemia. J Lab Physicians. 2010;2(1):14–6.
15. Umadevi S, Joseph NM, Kumari K, Easow JM, Kumar S, Stephen S, et al. Detection of extended spectrum beta lactamases, ampc beta lactamases and metallobetalactamases in clinical isolates of ceftazidime resistant Pseudomonas aeruginosa. Braz J Microbiol. 2011;42(4):1284–8.
16. Kaur M, Aggarwal A. Occurrence of the CTX-M, SHV and the TEM Genes Among the Extended Spectrum β-Lactamase Producing Isolates of Enterobacteriaceae in a Tertiary Care Hospital of North India. J Clin Diagn Res JCDR. 2013 Apr;7(4):642–5.
17. Swaminathan A, Ardra M, Manoharan A, Nair K, Girija K. Characterisation of carbapenemase-producing Gram-negative bacilli among clinical isolates in a tertiary care centre in Kerala, South India. J Acad Clin Microbiol. 2016;18(2):100–4.

Resmi Rajan

Professor, Dept of Microbiology, Government Medical College, Calicut- 673008, Kerala