title: High rates of multidrug resistance among uropathogenicEscherichia coliin children and analyses of ESBL producers from Nepal.
abstract: BACKGROUND
  Emergence of Extended-spectrum beta-lactamase producingEscherichia colicausing urinary tract infections (UTI) among pediatric patients is an increasing problem worldwide. However, very little is known about pediatric urinary tract infections and antimicrobial resistance trend from Nepal. This study was conducted to assess the current antibiotic resistance rate and ESBL production among uropathogenicEscherichia coliin pediatric patients of a tertiary care teaching hospital of Nepal.
  
  
  METHODS
  A total of 5,484 urinary tract specimens from children suspected with UTI attending a teaching hospital of Nepal over a period of one year were processed for the isolation of bacterial pathogens and their antimicrobial susceptibility testing.Escherichia coli(n= 739), the predominant isolate in pediatric UTI, was further selected for the detection of ESBL-production by phenotypic combination disk diffusion test.
  
  
  RESULTS
  Incidence of urinary tract infection among pediatric patients was found to be 19.68% andE coli(68.4%) was leading pathogen involved. Out of 739E coliisolates, 64.9% were multidrug resistant (MDR) and 5% were extensively drug resistant (XDR). Extended spectrum beta lactamase (ESBL) was detected in 288 (38.9%) of theE coliisolates.
  
  
  CONCLUSIONS
  Alarming rate of drug resistance among pediatric uropathogens and high rate of ESBL-producingE. coliwas observed. It is extremely necessary to routinely investigate the drug resistance among all isolates and formulate strict antibiotics prescription policy in our country.
authors.affiliation: Department of Clinical Laboratory Services, Manmohan Memorial Medical College and Teaching Hospital, P.O.B.: 15201, Swayambhu, Kathmandu, Nepal ; Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.
authors.forename: Narayan Prasad
authors.initials: NP
authors.lastname: Parajuli
authors.affiliation: Department of Clinical Laboratory Services, Manmohan Memorial Medical College and Teaching Hospital, P.O.B.: 15201, Swayambhu, Kathmandu, Nepal.
authors.forename: Pooja
authors.initials: P
authors.lastname: Maharjan
authors.affiliation: Department of Clinical Laboratory Services, Manmohan Memorial Medical College and Teaching Hospital, P.O.B.: 15201, Swayambhu, Kathmandu, Nepal.
authors.forename: Hridaya
authors.initials: H
authors.lastname: Parajuli
authors.affiliation: Department of Clinical Laboratory Services, Manmohan Memorial Medical College and Teaching Hospital, P.O.B.: 15201, Swayambhu, Kathmandu, Nepal.
authors.forename: Govardhan
authors.initials: G
authors.lastname: Joshi
authors.affiliation: Department of Clinical Laboratory Services, Manmohan Memorial Medical College and Teaching Hospital, P.O.B.: 15201, Swayambhu, Kathmandu, Nepal.
authors.forename: Deliya
authors.initials: D
authors.lastname: Paudel
authors.affiliation: Department of Pediatrics, Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal.
authors.forename: Sujan
authors.initials: S
authors.lastname: Sayami
authors.affiliation: Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.
authors.forename: Puspa Raj
authors.initials: PR
authors.lastname: Khanal
keywords: Children; E coli; ESBL; Nepal; Urinary tract infection