Acta Scientific Paediatrics (ISSN: 2581-883X)

Retrospective Study Volume 5 Issue 1

Antibiogram of Extended-spectrum Beta-lactamase (ESBL) and Non-ESBL Producers in Urinary Tract Infections in Children: A Six-year Retrospective Study

Bhaskar Shenoy1*, Archana M2, Ranjeeta Adhikary3 and Bhavana MV4

1Professor and Head, Department of Pediatrics, Manipal Hospital, Bangalore, Karnataka, India
2Associate Consultant, Department of Pediatrics, Manipal Hospital, Bangalore, Karnataka, India
3Consultant and Head, Department of Microbiology, Manipal Hospital, Bangalore, Karnataka, India
4Consultant, Department of Microbiology, Manipal Hospital, Bangalore, Karnataka, India

*Corresponding Author: Bhaskar Shenoy, Professor and Head, Department of Pediatrics, Manipal Hospital, Bangalore, Karnataka, India.

Received: December 22, 2021; Published: December 31, 2021


Objective: Urinary tract infection (UTI) is a common infection in children, due to the increased prevalence of antibiotic-resistant, extended-spectrum beta-lactamase (ESBL) and non-ESBL producers. Analyzing antibiotic sensitivity data and monitoring the changes in the susceptibility profiles is crucial for accurate diagnosis and treatment. This study aimed to retrospective analyze in vitro susceptibility profiles of gram-negative bacteria isolated in urine samples in a single institution.

Methods: Antibiotic sensitivity data were collected retrospectively from 1372 patients, aged 0-19 years, who were suffering from UTI. Data was analyzed for the prevalence of ESBL and non-ESBL producers. Wilcoxon Rank Sum Test, Chi-square test and odds ratios were used to compare the mean age, find the association and relative odds of having infection. Cochran-Armitage test was used to analyze the trend of antibiotic susceptibility test (AST) pattern. p- value of <0.05 was considered as statistically significant.

Results: A significant difference in the mean age and association between sex and ESBL and non-ESBL UTIs were noted (p < 0.05). Out of 1417 bacterial isolates from 1372 urine samples, E. coli (84.12%), followed by K. pneumoniae (12.63%) were the most predominant. Imipenem, meropenem, and ertapenem along with amikacin and netilmicin were highly effective against the ESBL producers; however, an increased resistance towards imipenem and meropenem was noted against non-ESBL producers (p < 0.001).

Conclusion: Carbapenems were effective against ESBL producers, along with amikacin and netilmicin. A declining AST pattern was observed for majority of antibiotics, except gentamicin against non-ESBL producers, suggesting the need for the practice of antibiotic stewardship.


Keywords: Antimicrobial Stewardship; Carbapenems; Child; Escherichia coli


  1. Behzadi P., et al. “A survey on urinary tract infections associated with the three most common uropathogenic bacteria”. Maedica 5 (2010): 111-115.
  2. Paterson A. “Urinary tract infection: an update on imaging strategies”. European Radiology 14 (2004): L89-100.
  3. Freedman AL. “Urinary tract infection in children”. In: Litwin MS, Saigal CS, eds. Urologic Diseases of America. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Publishing Office (2004): 213-232.
  4. Razak S, et al. “Bacteriology of urinary tract infection and antibiotic susceptibility pattern in a tertiary care hospital in South India”. International Journal of Medical Science and Public Health 2 (2012) :109-113.
  5. Gupta S., et al. “Urinary tract infection in pediatrics patients in north India”. IOSR Journal of Dental and Medical Sciences 11 (2013): 58-62.
  6. Sengupta S., et al. “The multifaceted roles of antibiotics and antibiotic resistance in nature”. Frontiers in Microbiology 4 (2013): 47.
  7. Mshana SE., et al. “Prevalence of multi resistant gram-negative organisms in a tertiary hospital in Mwanza, Tanzania”. BMC Research Notes 2 (2009): 49.
  8. Kurihara Y., et al. “Characteristics of bacteremia caused by extended-spectrum beta-lactamase-producing Proteus mirabilis”. Journal of Infection and Chemotherapy 19 (2013): 799-805.
  9. Storberg V. “ESBL-producing Enterobacteriaceae in Africa-a non-systematic literature review of research published 2008-2012”. Infection Ecology and Epidemiology 4 (2014): 20342.
  10. Schuetz AN., et al. “Point-counterpoint: Piperacillin-tazobactam should be used to treat infections with extended-spectrum-beta-lactamase-positive organisms”. Journal of Clinical Microbiology 56 (2018): e01917-17.
  11. Polwichai P., et al. “Antimicrobial resistance of Escherichia coli isolated from urine in Thailand from 2000 to 2005”. Journal of the Medical Association of Thailand 92 (2011): 59-67.
  12. Abera B., et al. “Extended-Spectrum beta (β)-lactamases and Antibiogram in Enterobacteriaceae from clinical and drinking water Sources from Bahir Dar City, Ethiopia”. PloS One 11 (2016): e0166519.
  13. Kaufman J., et al. “Urinary tract infections in children: an overview of diagnosis and management”. BMJ Paediatrics Open 3 (2019): e000487.
  14. Collee JG., et al. “Tests for identification of bacteria. In: JG Collee, JP Duguid, AG Fraser and BP Marmion, eds. Mackie and McCartney Practical Medical Microbiology”. Churchill Livingston: Elsevier (1989): 141-159.
  15. Jarlier V., et al. “Extended broad-spectrum β-lactamases conferring transferable resistance to newer β-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns”. Clinical Infectious Diseases 10 (1988): 867-878.
  16. Wayne PA. “Performance standards for antimicrobial susceptibility testing; 26th informational supplement. Clinical and Laboratory Standards Institute”. CLSI M100S (2016).
  17. Bhatt CP., et al. “Etiology of urinary tract infection and drug resistance cases of uropathogenes”. Journal of Kathmandu Medical College 1 (2012): 114-120.
  18. Tanko N., et al. “A systematic review on the prevalence of extended spectrum beta lactamase producing gram-negative bacteria in Nigeria”. Journal of Global Antimicrobial Resistance 22 (2020): 488-496.
  19. Musa BM., et al. “The burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in Nigeria: a systematic review and meta-analysis”. Transactions of the Royal Society of Tropical Medicine and Hygiene 114 (2020): 241-248.
  20. Balasubramanian S., et al. “Extended-spectrum beta-lactamase-producing community-acquired urinary tract infections in children: Chart review of risk factors”. Journal of Global Infectious Diseases 10 (2018): 222-225.
  21. Somashekara SC., et al. “Retrospective analysis of antibiotic resistance pattern to urinary pathogens in a Tertiary Care Hospital in South India”. Journal of Basic and Clinical Pharmacy 5 (2014): 105-108.
  22. John AS., et al. “A review on the prevalence and predisposing factors responsible for urinary tract infection among adults”. European Journal of Experimental Biology 6 (2016): 7-11.
  23. Melzer M., et al. “Mortality following bacteraemic infection caused by extended spectrum beta-lactamase (ESBL) producing E. coli compared to non-ESBL producing E. coli”. Journal of Infection 55 (2007): 254-259.
  24. Jan IS., et al. “Antimicrobial susceptibility testing for Klebsiella pneumoniae isolates resistant to extended-spectrum beta-lactam antibiotics”. Journal of the Formosan Medical Association 97 (1998): 661-666.
  25. Cho SY., et al. “Amikacin therapy for urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli”. The Korean Journal of Internal Medicine 31 (2016): 156-161.
  26. Ramesh N., et al. “Urinary tract infection and antimicrobial susceptibility pattern of extended spectrum of beta lactamase producing clinical isolates”. Advances in Biological Regulation 2 (2008): 78-82.
  27. Poovendran P., et al. “Antimicrobial susceptibility pattern of ESBL and non-ESBL producing uropathogenic Escherichia coli (UPEC) and their correlation with biofilm formation”. International Journal of Microbiology Research 4 (2013): 56-63.
  28. Agrawal P., et al. “Prevalence of extended-spectrum β-lactamases among Escherichia coli and Klebsiella pneumoniae isolates in a tertiary care hospital”. Indian Journal of Pathology and Microbiology 51 (2008): 139.
  29. Centers for Disease Control and Prevention report. “Antibiotic Resistance Threats in the United States” (2013).


Citation: Bhaskar Shenoy., et al. “Antibiogram of Extended-spectrum Beta-lactamase (ESBL) and Non-ESBL Producers in Urinary Tract Infections in Children: A Six-year Retrospective Study". Acta Scientific Paediatrics 5.1 (2022): 31-40.


Copyright: © 2022 Bhaskar Shenoy., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate33%
Acceptance to publication20-30 days
Impact Factor1.197

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is March 30, 2023.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US