Molecular analysis of multidrug-resistant E. coli in pediatric UTIs: findings from a Nigerian Hospital

Introduction: This study aimed to isolate and characterize antibiotic-resistant Escherichia coli from urine samples of children at the Mother and Child Hospital in Ondo State, Nigeria, assessing antibiogram profiling and resistance genes. Methodology: Three hundred urine samples (158 females, 142 males), aged 3-5 years, were collected, transported on ice, and analyzed bacteriologically. E. coli and Gram-negative bacteria were isolated using Eosin Methylene Blue agar and identified through colony morphology and biochemical tests. Antibiotic susceptibility was determined via Kirby Bauer's disc diffusion, and resistance genes were detected using Polymerase Chain Reaction (PCR). Results: Of the 300 samples, 40 (13.3%) yielded E. coli with varying antibiotic resistance profiles. The highest resistance was against Amoxicillin-clavulanate (87.5%) followed by Ceftriaxone (80%). Susceptibility was observed to Nitrofurantoin, Erythromycin, and Chloramphenicol. Multiple resistance patterns against 3-4 antibiotic classes were recorded, with 12 distinct patterns observed. Eight isolates harbored blaCTX-M gene, while five carried the aac3-IV gene. Conclusions: The study concluded a high occurrence of E. coli infection and multiple antibiotic resistance in the region. The presence of resistance genes suggests significant economic and health implications, emphasizing prudent antibiotic use under physician guidance to mitigate multiple antibiotic resistance

Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference

Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to healthcare, health system policies, provider bias or preferences, cultural beliefs, individual lifestyle concerns, potential care-partner time, and financial burdens. In May 2021, KDIGO (Kidney Disease: Improving Global Outcomes) convened a controversies conference on home dialysis, focusing on how modality choice and distribution are determined and strategies to expand home-dialysis use. Participants recognized that expanding use of home dialysis within a given health system requires alignment of policy, fiscal resources, organizational structure, provider incentives, and accountability. Clinical outcomes across all dialysis modalities are largely similar, but for specific clinical measures, one modality may have advantages over another. Therefore, choice among available modalities is preference-sensitive, with consideration of quality of life, life goals, clinical characteristics, family or care-partner support, and living environment. Ideally, individuals, their care-partners, and their healthcare teams will employ shared decision-making in assessing initial and subsequent kidney failure treatment options. To meet this goal, iterative, high-quality education and support for healthcare professionals, patients, and care-partners are priorities. Everyone who faces dialysis should have access to home therapy. Facilitating universal access to home dialysis and expanding utilization requires alignment of policy considerations and resources at the dialysis-center level, with clear leadership from informed and motivated clinical teams