Prevalence and molecular detection of ESBL genes in uropathogens isolated from children and adolescents in a General Hospital in Lagos, Nigeria

Background: Urinary tract infections (UTIs) are a significant global health concern with rising antimicrobial resistance (AMR) posing a serious challenge to effective treatment. The increasing prevalence of extendedspectrum beta-lactamase (ESBL)-producing uropathogens further complicates management, as these bacteria are resistant to third-generation cephalosporins and other β-lactam antibiotics. The objective of this study is to determine the prevalence and characterize ESBL genes in uropathogens isolated from children with UTIs in Ajeromi General Hospital, Ajegunle, Lagos, Nigeria.Methodology: A total of 165 children and adolescents presenting with symptoms of UTI were consecutively recruited into the study. Socio-demographic and clinical characteristics were collected from the participants using a structured data collection developed for the study. Voided midstream urine sample was collected from each participant. Standard microbiological methods were used to isolate and identify uropathogens from the sample, followed by antibiotic susceptibility testing (AST) using the Kirby-Bauer disk diffusion method. ESBL production was phenotypically detected by the double-disk synergy test (DDST), and conventional polymerase chain reaction (PCR) assay was performed to detect blaTEM and blaCTX-M1 ESBL genes.Results: Of the 165 children and adolescents whose urine samples were collected, 49 (26.7%) tested positive for significant bacterial growth, with Escherichia coli (53.1%) and Klebsiella pneumoniae (16.3%) being the predominant bacterial isolates. The AST revealed high resistance rates to third-generation cephalosporins (with 76.9% to ceftriaxone) and carbapenem (imipenem). While the phenotypic DDST did not confirm ESBL production in any of the isolates, PCR detected ESBL genes in 37 (75.5%) isolates.Conclusion: Our study highlights the widespread presence of ESBL-producing uropathogens, despite limitations in phenotypic detection methods, underscoring the need for routine molecular screening in AMR surveillance. The findings emphasize the critical role of antibiotic stewardship, infection control measures, empirical treatment guidelines, and promoting targeted molecular diagnostics in preventing the spread of multidrug-resistant (MDR) uropathogens.