Multi- and extensively drug resistant Escherichia coli isolated from South African children under 5 years old with diarrhoea.

• Escherichia coli were isolated from 90 children under the age of 5 years presenting with diarrhoea at clinics and hospitals in Limpopo province, South Africa. • 98.8 % (164/166) of isolates were categorized as multidrug resistant. • 4.9 % (9/166) of isolates were categorized as extensively drug resistant. • 92.2 % (153/166) of isolates were phenotypically extended-spectrum β-lactamase producers. Globally, millions of children die as a result of diarrhoea and/or antimicrobial resistant infections. Diarrhoeagenic Escherichia coli (DEC) are responsible for a substantial proportion of cases of diarrhoea in South Africa and sub-Saharan Africa. Effective treatments (including the use of antimicrobials) are therefore essential. E. coli isolated from children under the age of five were subjected to antimicrobial susceptibility testing using the Vitek 2® compact automated system (bioMérieux Inc., France) and categorized as multidrug or extensively drug resistant (MDR or XDR). Almost all isolates (164/166, 98.8 %) were categorized as MDR with 4.9 % (9/166) categorized as XDR. The majority of isolates (153/166, 92.2 %) were also phenotypically classified as extended-spectrum β-lactamase (ESBL) producers. More than half of these isolates (78/153, 51.0 %) were subjected to PCR for genes associated with ESBL production. More than half (45/78, 57.7 %) of the isolates tested were PCR positive for at least one ESBL gene or gene group and 11.5 % (9/78) were positive for two ESBL genes or gene groups. There is a need to strengthen antimicrobial resistance surveillance in South Africa and improve infection prevention and control measures. There is also a need to review the current South African Treatment Guidelines as outlined by the South African Essential Drugs Programme. [Display omitted] [ABSTRACT FROM AUTHOR]