Prevalence of Antibiotic Resistance of Gram-negative Bacteria Involved in Sepsis among Under Five Children in Akwa Ibom State, Nigeria

Background: The rising prevalence of multidrug-resistant (MDR) Gram-negative pathogens, including Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, has significantly contributed to increased mortality rates, particularly in resource-limited settings like Nigeria. Aim: This study characterized Gram-negative bacteria, their antibiotic resistance, and associated resistance genes in sepsis among children under five in Akwa Ibom State, Nigeria. Methods: A hospital-based descriptive observational study of neonates with or without clinical features of sepsis wasconducted at General Hospital Ikot Ekpene, University Teaching Hospital Uyo, and Immanuel Hospital Eket between June 2023 and December 2024. Methodology: A total of 180 children (0–5 years, both sexes) were included, with 60 participants from each hospital, recruited from outpatient, pediatric, gynecological, and immunization clinics. Blood samples (2 ml) were collected aseptically and cultured on thioglycollate broth, then subcultured on MacConkey, blood, and chocolate agar. Gram staining, biochemical characterization, and antimicrobial susceptibility testing were performed. Resistance genes were identified, and demographic, environmental, and social data were collected via caregiver interviews and structured questionnaires. Results: Of the 180 children, 123 tested positive for bacterial infections, with Escherichia coli (13.9%), Proteus mirabilis (10.6%), Pseudomonas aeruginosa (8.3%), and Klebsiella pneumoniae (6.7%) being the most common. Risk factors for sepsis were not statistically significant (P > 0.05), except for location (P < 0.05), with Uyo Teaching Hospital showing higher significance. P. aeruginosa exhibited 100% resistance to all 12 tested antibiotics. Resistance gene analysis revealed that E. coli, P. aeruginosa, and K. pneumoniae harbored blaSHV, PAGS, PASS, Cnf1, and hlyC genes. Pseudomonas and Klebsiella carried the blaTEM gene, while only Klebsiella harbored FimH. Conclusion: Gram-negative bacteria exhibit significant antibiotic resistance, posing challenges in managing infections in young children. Gene relatedness analysis revealed a link between K. pneumoniae and P. aeruginosa. Early identification through screening tools and sepsis bundles in emergency departments is essential for timely intervention and improved outcomes.