Dual carbapenem-fluoroquinolone resistance in community-onset pediatric urinary tract infections: Phenotypic-genotypic integration in three cases
Abstract
Urinary tract infections (UTIs) are among the most prevalent pediatric bacterial infections, and undertreated episodes may lead to renal scarring, hypertension, or chronic kidney disease. Multidrug-resistant (MDR) Enterobacterales have been increasingly reported in children, with higher rates in Asian and Middle Eastern settings than in high-income countries[1,2]. What is still considered uncommon in pediatrics is concomitant carbapenem and fluoroquinolone resistance (CFR): even large 10-year pediatric series found carbapenem resistance in only 2.1%-2.9% of isolates, suggesting that the subgroup that is both carbapenem-resistant and fluoroquinolone-resistant is small but clinically important[3]. Current Infectious Diseases Society of America (IDSA) guidance recommends the use of molecular assays for antibiotic resistance genes to reconcile phenotype and genotype in MDR or complicated Gram-negative infections, but actual use in low- and middle-income countries is limited by cost and laboratory capacity[4,5]. We retrospectively identified three community-onset pediatric UTIs in Vietnam, all in children without classic healthcare-associated risk factors, caused by MDR Enterobacterales exhibiting dual carbapenem and fluoroquinolone resistance. Each case was successfully managed by integrating automated antimicrobial susceptibility testing with a targeted multiplex polymerase chain reaction (PCR) resistance panel. This phenotype-genotype integration supported…
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