Extended-Spectrum Beta-Lactamase-Producing Uropathogens in Pediatric UTIs: Molecular Characteristics, Clinical Impact and Public Health Consequences
Nzube F. Ekpunobi *
Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria.
Malachy C. Ugwu
Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria.
Kingsley C. Agu
Department of Applied Microbiology and Brewing, Faculty of Biosciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria.
Chukwunwejim, C. R
Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria.
Eddison Igho Oghonyon
David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria.
Temitope Ogunmola
Department of Biochemistry, Federal University of Technology, Akure, Nigeria.
Oluwabunmi Seun Ajasa
Department of Molecular Biology and Genomics, Global Health and Infectious Disease Institute, Nasarawa State University, Nigeria.
Sandra Chiamaka Okoye
Department of Biological Sciences, Eastern Illinois University, United States of America.
Nwasoluchukwu Obidi
Department of Parasitology and Entomology, Nnamdi Azikiwe University, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Urinary tract infections (UTIs) remain a common and serious health challenge among pediatric populations, particularly in low- and middle-income countries. The emergence of extended-spectrum beta-lactamase (ESBL)-producing uropathogens significantly complicates treatment, increases the risk of complications, and burdens already fragile healthcare systems. This review provides a comprehensive analysis of the epidemiology, molecular mechanisms, clinical impact, and treatment challenges associated with ESBL-producing Enterobacteriaceae in pediatric UTIs, with a focused lens on Nigeria and the broader Sub-Saharan African region.
We examine the predominance of Escherichia coli and Klebsiella pneumoniae as key ESBL producers, highlight the molecular dominance of CTX-M-15 and co-existing resistance determinants, and discuss the role of clonal expansion and horizontal gene transfer in the spread of resistance. Regional surveillance data reveal alarming ESBL prevalence rates of 40–75%, with multidrug resistance further narrowing treatment options. The implications are profound—ranging from delayed treatment and increased hospitalization to long-term renal complications in children.
Despite the availability of phenotypic and molecular diagnostics, challenges persist due to limited access, infrastructural gaps, and under-resourced healthcare systems. This review underscores the urgent need for improved antimicrobial stewardship, investment in rapid diagnostics, and the establishment of pediatric-specific treatment guidelines. Addressing the burden of ESBL-producing uropathogens in Nigerian children is critical not only for safeguarding individual patient outcomes but also for mitigating the regional and global spread of antimicrobial resistance.
Keywords: Pediatric, urinary tract infections (UTIs), ESBL, multidrug resistance (MDR), Nigeria