A MULTICENTRIC STUDY ON GENOMIC INSIGHTS OF ESBL PRODUCING ESCHERICHIA COLI CAUSING COMMUNITY-ACQUIRED URINARY TRACT INFECTION IN CHILDREN IN INDIA: PREDICTING NEAR FUTURE

Abstract

Intro: Urinary tract infection (UTI) is one of the most common infections in children. Escherichia coli is the predominant organism causing UTI. The emergence of ESBL+ve E.coli harbouring other resistance genes poses a major challenge to clinicians. Though antimicrobial resistance (AMR) is of global concern, gathering local data in community-settings cannot be overemphasized. It is prudent to have knowledge about the genome of ESBL+ve E.coli at the country level to mitigate the risk in near future. Methods: Children (2-18 years) having UTI symptoms for less than a week in community health centres of Delhi, Bangalore, Jodhpur and Bhubaneswar representing north, south, west and east India were enrolled from 2019-2021. Phenotypic identification and antimicrobial susceptibility testing of the isolates causing significant bacteriuria was performed using MALDI-TOF and VITEK 2. Nineteen ESBL+ve E. coli isolates were analyzed by whole genome sequencing. Findings: 9.1% (42/461) of children were positive causing significant bacteriuria. [M:F 1:1, > 50% > 10 years]. E.coli was the predominant uropathogen (83.3%, 35/42) followed by Klebsiella pneumoniae (12%, 5/42), and Proteus spp. (4.7%, 2/42). Sixty percent of the E.coli isolates were ESBL producers. Genome sequence of the ESBL+ve E.coli was observed to carry large number of AMR genes such as blaNDM-5, blaOxa-1, blaCTX-M-15/14, AmpC, AAC(3)-IIa/IIc/Ib and others. ST131phylogroup was the most prevalent. Plasmid IncFIB and IncFIA found in more than 50% isolates. Composite transposon, IS26 was found in many isolates carrying blaOxa-1, blaNDM-5, blaCTX-M-15/14, blaTEM, aac(3′)-lb with at least 98% identity and coverage. Conclusion: Our data represents a large-scale nationwide community study among children indicating ESBL+ve E.coli isolates harbouring multidrug-resistant genes with high-risk clones. There is an urgent need for augmented surveillance at the local level for the recent knowledge of AMR patterns in the community; thereby preventing the imminent threat of an epidemic of AMR in near future.