Drug Resistance Analysis of Pathogens Isolated from Pediatric Patients in Mexico

Abstract

Objective To analyze the resistance to antimicrobials in clinical isolates from pediatric patients in Mexico.

Methods Susceptibility data from relevant specimens were collected in the pediatric population over 6 months from 25 centers from 17 states of Mexico and analyzed using the WHONET 5.6 software. Data were stratified into three age groups: younger than 2 years, 2 to 6 years, and 6 to 18 years.

Results For Escherichia coli, the infant/toddler group had higher resistance rates to ampicillin, ampicillin-sulbactam, cefuroxime, cefepime, gentamicin, quinolones (p < 0.001), amoxicillin/clavulanic acid (p = 0.003), and ceftazidime (p = 0.004) than the other two age groups. Additionally, a high proportion of extended-spectrum β-lactamase (ESBL)-producing isolates for E. coli (75.3%) was detected in this age group. Comparable results were observed for Klebsiella pneumoniae, with higher resistance to ampicillin-sulbactam, ceftazidime, gentamicin, cefepime, trimethoprim-sulfamethoxazole, carbapenems (p = 0.001) and amoxicillin/clavulanic acid (p = 0.023) in the infant/toddler group. Moreover, a high proportion of ESBL producers (76%) was detected in this age group. Regarding wards, E. coli and K. pneumoniae had the highest carbapenem resistance in the ICU area, and Acinetobacter baumannii had the highest carbapenem resistance in medical wards.

Conclusion High antibiotic resistance rates were detected in the infant/toddler group. This report presents baseline data for future prospective surveillance studies of antimicrobial resistance in pediatric patients in Mexico.

Keywords

antimicrobial resistance - methicillin-resistant - carbapenem-resistant Enterobacterales - pediatric patients

Publication History

Received: 09 February 2023

Accepted: 05 July 2023

Article published online:
14 August 2023

• References

• 1 Rice LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis 2008; 197 (08) 1079-1081
• 2 Barrios H, Silva-Sanchez J, Reyna-Flores F. et al. Detection of a NDM-1-producing Klebsiella pneumoniae (ST22) clinical isolate at a pediatric hospital in Mexico. Pediatr Infect Dis J 2014; 33 (03) 335
• 3 Aquino-Andrade A, Merida-Vieyra J, Arias de la Garza E, Arzate-Barbosa P, De Colsa Ranero A. Carbapenemase-producing Enterobacteriaceae in Mexico: report of seven non-clonal cases in a pediatric hospital. BMC Microbiol 2018; 18 (01) 38
• 4 Garza-Ramos U, Morfin-Otero R, Sader HS. et al. Metallo-beta-lactamase gene bla(IMP-15) in a class 1 integron, In95, from Pseudomonas aeruginosa clinical isolates from a hospital in Mexico. Antimicrob Agents Chemother 2008; 52 (08) 2943-2946
• 5 Romandini A, Pani A, Schenardi PA, Pattarino GAC, De Giacomo C, Scaglione F. Antibiotic resistance in pediatric infections: global emerging threats, predicting the near future. Antibiotics (Basel) 2021; 10 (04) 393
• 6 World Health Organization. . Children's immature immune systems threatened by increasing 'superbugs. 2021. Accessed August 10, 2021 at: https://www.who.int/news-room/commentaries/detail/children-s-immature-immune-systems-threatened-by-increasing-superbugs
• 7 Buccellato E, Melis M, Biagi C, Donati M, Motola D, Vaccheri A. Use of antibiotics in pediatrics: 8-years survey in Italian hospitals. PLoS One 2015; 10 (09) e0139097
• 8 Ciofi Degli Atti ML, D'Amore C, Ceradini J. et al. Prevalence of antibiotic use in a tertiary care hospital in Italy, 2008-2016. Ital J Pediatr 2019; 45 (01) 63
• 9 Araujo da Silva AR, Albernaz de Almeida Dias DC, Marques AF. et al. Role of antimicrobial stewardship programmes in children: a systematic review. J Hosp Infect 2018; 99 (02) 117-123
• 10 Kronman MP, Gerber JS, Grundmeier RW. et al. Reducing antibiotic prescribing in primary care for respiratory illness. Pediatrics 2020; 146 (03) e20200038
• 11 Fleming-Dutra KE, Hersh AL, Shapiro DJ. et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA 2016; 315 (17) 1864-1873
• 12 Taine M, Offredo L, Dray-Spira R, Weill A, Chalumeau M, Zureik M. Paediatric outpatient prescriptions in France between 2010 and 2019: a nationwide population-based study: Paediatric outpatient prescriptions in France, 2010 to 2019. Lancet Reg Health Eur 2021; 7: 100129
• 13 Leber AL. Clinical Microbiology Procedures Handbook. 4th ed. Vol. 1. Washington, DC: American Society of Microbiology; 2016
• 14 Performance Standards for Antimicrobial Susceptibility Testing. Twenty-Second Informational Supplement. Wayne, PA: Clinical and Laboratory Standars Institute; 2020
• 15 Fox-Lewis A, Takata J, Miliya T. et al. Antimicrobial resistance in invasive bacterial infections in hospitalized children, Cambodia, 2007-2016. Emerg Infect Dis 2018; 24 (05) 841-851
• 16 Weiner-Lastinger LM, Abner S, Benin AL. et al. Antimicrobial-resistant pathogens associated with pediatric healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015-2017. Infect Control Hosp Epidemiol 2020; 41 (01) 19-30
• 17 Agyepong N, Govinden U, Owusu-Ofori A, Essack SY. Multidrug-resistant gram-negative bacterial infections in a teaching hospital in Ghana. Antimicrob Resist Infect Control 2018; 7: 37
• 18 Sun D, Cong P, Guan F, Liu S, Sun L, Zhang G. Urine culture in hospitalized patients during 2014-2018: an analysis on pathogen distribution and drug sensitivity. Dis Markers 2021; 2021: 6646024
• 19 Lake JG, Weiner LM, Milstone AM, Saiman L, Magill SS, See I. Pathogen distribution and antimicrobial resistance among pediatric healthcare-associated infections reported to the national healthcare safety network, 2011-2014. Infect Control Hosp Epidemiol 2018; 39 (01) 1-11
• 20 Arana DM, Rubio M, Alós JI. Evolution of antibiotic multiresistance in Escherichia coli and Klebsiella pneumoniae isolates from urinary tract infections: a 12-year analysis (2003-2014). Enferm Infecc Microbiol Clin 2017; 35 (05) 293-298
• 21 Ramírez-Castillo FY, Moreno-Flores AC, Avelar-González FJ, Márquez-Díaz F, Harel J, Guerrero-Barrera AL. An evaluation of multidrug-resistant Escherichia coli isolates in urinary tract infections from Aguascalientes, Mexico: cross-sectional study. Ann Clin Microbiol Antimicrob 2018; 17 (01) 34
• 22 Rather PN, Munayyer H, Mann PA, Hare RS, Miller GH, Shaw KJ. Genetic analysis of bacterial acetyltransferases: identification of amino acids determining the specificities of the aminoglycoside 6′-N-acetyltransferase Ib and IIa proteins. J Bacteriol 1992; 174 (10) 3196-3203
• 23 Rutledge-Taylor K, Matlow A, Gravel D. et al; Canadian Nosocomial Infection Surveillance Program. A point prevalence survey of health care-associated infections in Canadian pediatric inpatients. Am J Infect Control 2012; 40 (06) 491-496
• 24 Cheung GY, Otto M. Understanding the significance of Staphylococcus epidermidis bacteremia in babies and children. Curr Opin Infect Dis 2010; 23 (03) 208-216
• 25 Zhang Q, Xu X, Langley JM, Zhu B, Zhang N, Tang Y. Health-associated infections in a pediatric nephrology unit in China. Am J Infect Control 2010; 38 (06) 473-475
• 26 Gasink LB, Edelstein PH, Lautenbach E, Synnestvedt M, Fishman NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Infect Control Hosp Epidemiol 2009; 30 (12) 1180-1185
• 27 Arnold RS, Thom KA, Sharma S, Phillips M, Kristie Johnson J, Morgan DJ. Emergence of Klebsiella pneumoniae carbapenemase-producing bacteria. South Med J 2011; 104 (01) 40-45
• 28 Codjoe FS, Donkor ES. Carbapenem resistance: a review. Med Sci (Basel) 2017; 6 (01) 1
• 29 Rodríguez-Baño J, Rossolini GM, Schultsz C. et al. Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance. Trans R Soc Trop Med Hyg 2021; 115 (10) 1122-1129
• 30 Langford BJ, So M, Raybardhan S. et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect 2021; 27 (04) 520-531
• 31 Karun A, Kaur RJ, Charan J. et al. Impact of COVID-19 on antimicrobial resistance in paediatric population: a narrative review. Curr Pharmacol Rep 2022; 8 (05) 365-375
• 32 Velasco-Arnaiz E, López-Ramos MG, Simó-Nebot S. et al; Kids Corona project. Pediatric antimicrobial stewardship in the COVID-19 outbreak. Infect Control Hosp Epidemiol 2021; 42 (05) 642-644
• 33 Al Jarousha AM, El Jadba AH, Al Afifi AS, El Qouqa IA. Nosocomial multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit in Gaza City, Palestine. Int J Infect Dis 2009; 13 (05) 623-628
• 34 Okomo U, Akpalu ENK, Le Doare K. et al. Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines. Lancet Infect Dis 2019; 19 (11) 1219-1234
• 35 Cruz-Córdova A, Mancilla-Rojano J, Luna-Pineda VM. et al. Molecular epidemiology, antibiotic resistance, and virulence traits of Stenotrophomonas maltophilia strains associated with an outbreak in a Mexican tertiary care hospital. Front Cell Infect Microbiol 2020; 10: 50
• 36 Torumkuney D, de la Torre C, Langfeld K, Lopez-Turrent NP, Ossaille Beltrame C. Country data on AMR in Mexico in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome. J Antimicrob Chemother 2022; 77 (Suppl_1): i43-i50