Analysis of Carbapenemase and Extended-spectrum Beta-lactamasesproducing Cephalosporin-resistant Strain of Escherichia coli and Klebsiella pneumoniae among Children in a Tertiary Care Centre, South India

The incidence of Extended-Spectrum Beta-Lactamase (ESBL)- and carbapenemase-producing enterobacteriaceae in enterobacterales is increasing globally, pos-ing a threat to health. Schoolchildren under adolescence show a gradual increase in immunity, and respiratory infections like pneumonia and others are more prevalent in children under five-years of age. However, gastrointestinal disorders primarily affect children under one-year of age.
Aims:

The study aimed to analyze the Extended-spectrum Beta-Lactamase (ESBL) and car-bapenemase-producing cephalosporin-resistant strain of Escherichia coli and Klebsiella pneumoniae, isolated from various specimens of hospitalized children below ten years of age.
Methods:

A cross-sectional study on laboratory reports of positive culture specimens from children below ten years of age was conducted to analyze the cephalosporin-resistant strains of E. coli and K. pneumoniae between July, 2023 and July, 2024 in the Microbiology depart-ment of a tertiary care hospital central Kerala, South India. The cephalosporin-resistant strain was analyzed for carbapenemase or ESBL presence using a double disc synergy test. The data were subjected to statistical analysis.
Results and Discussion:

A total of 1636 culture reports were analyzed, and growth was found in 672 (41%) specimens. Among the cephalosporin-resistant 187 strains (66%), E. coli and K. pneumoniae were 106 (57%) and 81 (43%), respectively. A significant difference (p <0.05) was noted between cephalosporin-resistant and sensitive E. coli among the various age groups. The dif-ference between cephalosporin-resistant and susceptible K. pneumoniae across different age groups, however, was negligible (p>0.05). Carbapenemase and ESBL-producing E. coli and K. pneumoniae were 39%, 29%, and 48%, respectively. The carbapenemase and ESBL-pro-ducing strains were more in children below one year. An insignificant difference (p>0.05) between ESBL (+) and ESBL (-) E. coli or K. pneumoniae was found among various age groups. A similar observation was found between carbapenemase [+] and carbapenemase (-) E. coli or K. pneumoniae. According to the effect value (Cramer's V) determined for each comparison, the association was either very weak or negligible.
Conclusion:

The cephalosporin-resistant strains (66%) of E. coli and K. pneumoniae were 57% and 43%, respectively. Specimens of children below one year of age showed more inci-dence of ESBL-producing K. pneumonia (67%) and carbapenemase-producing E. coli (68%).