Carbapenem resistance in pediatric Acinetobacter baumannii urinary tract infections: molecular determinants

BACKGROUND: In the pediatric population, carbapenem-resistant Acinetobacter baumannii (CRAB) is a significant cause of hospital-acquired infections, particularly hospital-acquired urinary tract infections (HA-UTIs). There are a few studies on the molecular mechanisms of resistance to CRAB among children. OBJECTIVE: To detect the prevalence of CRAB among children with HA-UTIs and to evaluate associated carbapenemase genes and clinical risk factors. METHODS: This cross-sectional study included 100 children with HA-UTIs. Isolates were identified using standard microbiology techniques, and antimicrobial resistance (AMR) was detected according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Carbapenemase genes (blaOXA-23-like, blaOXA-24/40-like, blaOXA-58-like, and blaNDM) were detected by PCR. Data were statistically analyzed to assess the association between clinical factors and carbapenem resistance (CR). RESULTS: CR was identified in 73% of isolates. High rates of AMR were observed for cephalosporins and fluoroquinolones. The most prevalent gene was the blaOXA-23-like gene (60%), followed by the blaOXA-58-like (34%), the blaOXA-24/40-like (30%), and the blaNDM (15%). A significant association was observed between resistance to carbapenems and the carbapenemase genes blaOXA-23-like and blaNDM (p < 0.05). Clinical factors like ICU admission and catheterization did not show a significant association with resistance. CONCLUSION: Carbapenem resistance among pediatric Acinetobacter baumannii UTIs is highly prevalent and primarily driven by molecular mechanisms, particularly OXA-23 and NDM carbapenemases. This underscores the significance of molecular diagnostics and infection control in pediatric healthcare settings.