{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:57:38Z","timestamp":1780981058834,"version":"3.54.1"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Diarrheagenic\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      (DEC) is a major cause of pediatric diarrhea, particularly in low- and middle-income countries. Antimicrobial resistance, including extended-spectrum \u03b2-lactamase (ESBL) production, further complicates clinical management. This study investigated DEC pathotypes, resistance patterns, ESBL prevalence and integron carriage among children with acute diarrhea in Mansoura, Egypt.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A total of 120 children (median age 6 years; 50.8% male) presenting with acute diarrhea were enrolled. Clinical data were recorded, and stool samples were cultured for\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      . Phenotypic antibiotic susceptibility testing, ESBL detection and polymerase chain reaction assays for DEC pathotypes and class I\/II integrons were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      was isolated from 60 (50%) children. The predominant pathotype was Shiga toxin\u2013producing\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      (STEC, 46.7%), followed by typical enteropathogenic\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      (tEPEC, 45%) and atypical EPEC (aEPEC, 8.3%). High resistance rates were observed for amoxicillin\/clavulanic acid (85%), cefadroxil (60%) and ampicillin (58.3%). ESBL production was detected in 41.7% of isolates. Class I and II integrons were identified in 51.7% and 16.7% of isolates, respectively, with a strong association between both integrons in STEC and tEPEC (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). No significant association was found between integron carriage and ESBL production (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.34) or antibiotic resistance profiles.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>DEC is a significant cause of pediatric diarrhea in Egypt, with STEC and tEPEC predominating. The high prevalence of antimicrobial resistance, ESBL production and integron carriage underscores the urgent need for surveillance programs, antimicrobial stewardship and improved infection control to limit resistance dissemination in pediatric populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/inf.0000000000005151","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T05:00:21Z","timestamp":1769058021000},"page":"616-619","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["ESBL and Integron Profiles in Pediatric EPEC\/STEC"],"prefix":"10.1097","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6982-1216","authenticated-orcid":false,"given":"Noha","family":"Mostafa Mahmoud","sequence":"first","affiliation":[{"name":"Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-9599","authenticated-orcid":false,"given":"Amira M.","family":"Sultan","sequence":"additional","affiliation":[{"name":"Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5431-0248","authenticated-orcid":false,"given":"Maysaa","family":"El Sayed Zaki","sequence":"additional","affiliation":[{"name":"Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4978-0987","authenticated-orcid":false,"given":"Noha","family":"Tharwat Abou El-Khier","sequence":"additional","affiliation":[{"name":"Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0872-5471","authenticated-orcid":false,"given":"Mohammed","family":"Gohar Mohammed El Sherbeny","sequence":"additional","affiliation":[{"name":"Medical Microbiology and Immunology Department, Faculty of Medicine, Al-Azhar University, New Damietta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2222-4528","authenticated-orcid":false,"given":"Omnia","family":"Ahmed Mohamed Salem","sequence":"additional","affiliation":[{"name":"Pediatric Department, Faculty of Medicine, Mansoura University, Mansoura"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3024-8803","authenticated-orcid":false,"given":"Sara","family":"Ahmed Mohamed Morsy","sequence":"additional","affiliation":[{"name":"Clinical Pathology Department, Faculty of Medicine, Beni-suef University, Beni-suef, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8731-2581","authenticated-orcid":false,"given":"Mai","family":"Esam Ahmed","sequence":"additional","affiliation":[{"name":"Clinical Pathology Department, Faculty of Medicine, Beni-suef University, Beni-suef, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"R1-20260609","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1128\/CMR.16.3.365-378.2003","article-title":"Virulence of enteropathogenic Escherichia coli, a global pathogen.","volume":"16","author":"Clarke","year":"2003","journal-title":"Clin Microbiol Rev"},{"key":"R2-20260609","doi-asserted-by":"crossref","first-page":"318","DOI":"10.7883\/yoken.JJID.2009.318","article-title":"Prevalence and properties of diarrhoeagenic Escherichia coli among healthy individuals in Osaka City, 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