Abstract

Extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases are key mechanisms behind β-lactam antibiotic resistance, particularly in Gram-negative bacteria. In Nepal, antibiotic-resistant bacterial infections pose a growing public health concern among children. However, there is limited pediatric-focused evidence on ESBL and AmpC β-lactamase production. To address this gap, cross-sectional, hospital-based study assessed β-lactamase-mediated resistance among pediatric patients at the International Friendship Children’s Hospital, Nepal, between August 2017 and February 2018. A total of 1,139 clinical samples (880 urine and 259 pus) were processed using standard microbiological techniques. Of these, 31 isolates of Klebsiella pneumoniae (urine) and 10 of Pseudomonas aeruginosa (pus) were identified. Phenotypic detection of ESBLs was performed using the combination disc test, and AmpC β-lactamase production was assessed using the cefoxitin–cloxacillin double-disc synergy test and found 32.2% of and 40% of positive ESBL, while 46.2% and 33.3% positive AmpC β-lactamases for K. pneumoniae and P. aeruginosa isolates respectively. AmpC production was observed in. Co-production of ESBL and AmpC occurred in four K. pneumoniae and one P. aeruginosa isolate. Multidrug resistant (MDR) and Extensively drug resistant (XDR) were seen in 35.5% and 16.1% of K. pneumoniae and 40% and 20% of P. aeruginosa isolates, respectively. Meropenem, piperacillin-tazobactam, and gentamicin were the most effective antibiotics. These findings underscore the urgent need for routine resistance surveillance and evidence-based antibiotic policies to support effective pediatric infection management in Nepal.