Urinary Tract Infection in Pediatrics: Study of Uropathogens and Their Resistance in a Madrid Hospital

Abstract

Introduction: Resistance to antibiotics is a growing problem with repercussions on the choice of first-line treatment in urinary tract infection (UTI) in childhood.

Objectives: To know the current pattern of antibiotic susceptibility/resistance of the most frequent germs that cause UTI in our healthcare area. Secondary objective is to know the evolution of these patterns over time.

Patients and methods: A cross-sectional retrospective study of UTI episodes in a first-level hospital in two periods: 1st January 2008-31th December 2010 and 1st January 2017-31th December 2019 through a review of medical records, recording the following variables: Age, sex, fever, hospital admission, uropathy/bladder dysfunction, antibiotic prophylaxis.

Results: First period: 174 UTI episodes (156 patients); Second period: 266 UTI episodes (218 patients). The most frequently isolated germ was E. coli, but in patients with uropathy or bladder dysfunction, the percentage of different germs is greater. A significant increase in resistance to amoxicillin/clavulanate (from 12.2 to 24%) is observed between both periods, it remains stable and in an acceptable range for gentamicin, cotrimoxazole and slightly increases to first-generation cephalosporins. In patients with uropathy/bladder dysfunction, resistance to all these antibiotics is significantly increased.

Conclusions: The increased resistance of the most frequent uropathogens in the UTI of the pediatric population of our healthcare area to amoxicillin/clavulanate makes it unsuitable as empirical therapy. First-generation cephalosporins are an adequate alternative in patients without risk factors.

Keywords: antibiotic resistance; empirical treatment; urinary tract infection.