Five-Year Trends in Multidrug- and Extensively Drug-Resistant Enterobacterales Causing Pediatric Urinary Infections in Southern Türkiye: A Surveillance Report.

Authors

Şinasi Karvar, Sibel Gümüş, Elçin Kal Çakmaklıoğulları

Published in

The Eurasian journal of medicine. Volume 58. Issue 3. Pages 1-7. Apr 22, 2026. Epub Apr 22, 2026.

Abstract

This study aimed to assess species distribution, antimicrobial susceptibility, and temporal trends in multidrug-resistant (MDR), extensively drug-resistant (XDR), and extended-spectrum beta-lactamase (ESBL)-suspect phenotypes among pediatric urinary Enterobacterales isolates at a tertiary center.
The authors retrospectively reviewed positive urine cultures from patients younger than 18 years between January 2020 and August 2025. Species identification and antimicrobial susceptibility testing (AST) were performed primarily with VITEK 2, supplemented with biochemical tests and disk diffusion when needed. Multidrug-resistant (MDR), XDR, and pandrug-resistant (PDR) phenotypes were classified according to standard definitions. The ESBL-suspect phenotype was defined as concurrent non-susceptibility to at least one third-generation cephalosporin and to aztreonam. Trend analyses were limited to 2020-2024.
Among 2889 Enterobacterales isolates, species distribution was as follows: Escherichia coli 69.4%, Klebsiella spp. 20.6%, Proteus spp. 5.6%, Enterobacter spp. 2.1%, others 1.9%. Over time, MDR increased in E. coli (37.7% to 57.8%), with parallel increases in ESBL-suspect and XDR phenotypes. In Klebsiella spp., XDR rose from 6.3% to 11.4%. Pandrug-resistant phenotype was detected only in 3 Klebsiella isolates and not in other species. Susceptibility to carbapenems and amikacin was largely preserved throughout the study. In E. coli, nitrofurantoin and fosfomycin retained high activity, whereas oral options were limited for Klebsiella spp.
The rising MDR burden in pediatric Enterobacterales and the increase in XDR among Klebsiella spp. warrant regular revision of empiric therapy protocols. Preserved susceptibility to carbapenems and amikacin remains important for severe cases. Age-aware, time-trend surveillance that couples species distribution with resistance trajectories can strengthen antimicrobial stewardship. Cite this article as: Karvar Ş, Gümüş S, Çakmaklıoğulları EK. Five-year trends in multidrug- and extensively drug-resistant Enterobacterales causing pediatric urinary infections in southern Türkiye: a surveillance report. Eurasian J Med. 2026, 58(3), 1244, doi:10.5152/eurasianjmed.2026.251244.

PMID:
42364196
Bibliographic data and abstract were imported from PubMed on 28 Jun 2026.

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