Epidemiology of Community Origin of major multidrug-resistant ESKAPE uropathogens in a paediatric population in South-East Gabon

Abstract

Abstract Background: Urinary tract infections (UTIs) in children are very common. They are often associated with a high risk of sepsis and death. In addition, antibiotic resistance of UTI pathogens isolated from children is steadily increasing, especially against commonly used antibiotics. The study’s main objective was to examine the epidemiology of community origin and antibiotic sensitivity of major ESKAPE uropathogens in paediatric UTIs in South-East Gabon. Methods:The study was conducted from January 2018 to December 2021 and involved 508 children aged 0-17 years. Identification of bacterial isolates was carried out using the Vitek-2 compact automated system and the antibiogram with the disk diffusion and microdilution methods according to the European Committee on Antimicrobial Susceptibility Testing recommendations. Results: The prevalence of UTIs was 59%. E. coli and K. pneumoniae were the main ESKAPE involved in UTIs followed by Enterococcus spp. and S.aureus. The multidrug-resistant (MDR) phenotype was the most common. DTR-E. coli, CRE-K. pneumoniae and MDR-K. pneumoniae were associated with pyelonephritis. MRSA UTIs were frequent in symptomatic children. ESC-E. coli and MRSA were associated with recurrent UTIs while VRE and ESC-E. coli were associated with empirical treatment failures. MDR-E. coli, ESC-E. coli, MDR-K. pneumoniae, ESC-K. pneumoniae, UDR-K. pneumoniae, CRE-K. pneumoniae and XDR-K. pneumoniae were associated with rural paediatric populations. Conclusion: This study describes the resistance phenotypes DTR, UDR and MAR index in Gabon. It showed a high prevalence of paediatric UTIs with high frequency of E. coli, K. pneumoniae, Enterococcus spp. and S. aureus with heterogeneous resistance profiles (MDR, XDR, DTR, ESC, CRE, MRSA and VRE).