General Characteristics and Current State of Antibiotic Resistance in Pediatric Urinary Tract Infection-A Single Center Experience

Abstract

Urinary tract infection (UTI) represents one of the most common bacterial infections in children, mainly caused by Gram-negative bacteria. Empirical antibiotic treatment is based on international and national guidelines for treating UTIs in children and is individualized with local antibiotic resistance patterns. The aim of this study is to bring a clear view of present-day particularities of UTIs in children.

Methods: We analyzed 210 positive urine cultures identified in 141 pediatric patients admitted to the hospital over a 6-month period.

Results: The majority of patients were females (57%) with a median age of 5 years (IQR 12), while male patients revealed a median age of 2 (IQR 7). Most patients originated from urban areas (53%). Only 18 patients (12.76%) were identified with underlying Congenital Anomalies of the Kidney and Urinary Tract (CAKUT). Escherichia Coli was the most frequent pathogen. Increased antibiotic resistance was found in commonly-used antibiotics Ampicillin and Trimethoprim/Sulfamethoxazole, and in the case of patients with CAKUT. Suitable antibiotics for treating a Gram-negative UTI are aminoglycosides, Meropenem, third-generation Cephalosporins, and Nitrofurantoin. Vancomycin upholds efficacy in treating a Gram-positive pediatric UTI.

Conclusion: Periodical analysis needs to be performed in order to constantly update clinicians on uropathogenic antibiotic resistance and optimal empirical treatment options.

Keywords: antibiotic resistance; children; kidney anomalies; urinary tract infection.

Figure 1

Age-sex distribution of patients (left); sex-environment distribution (right). Red square—female patients; blue square—male patients.

Figure 2

Patient age distribution with presence/absence of malformation. Red square—female patients; blue square—male patients; CAKUT—Congenital Anomalies of Kidney and Urinary Tract.

Figure 3

Patient sex distribution with number of UTIs and presence/absence of malformation. Green square—no malformation. Brown square—CAKUT.

Figure 4

UTI pathogens model: Predictive probability plot. GNE—Gram-negative bacteria belonging to Enterobacteriaceae Fam.; GNP—Gram-negative bacteria belonging to Pseudomonaceae spp.; GP—Gram-positive bacteria. Red line—Fungous; green line—GNE pathogen; blue line—GNP pathogen; purple line—GP pathogen. All continuous lines refer to urban origin environment, and all dotted lines refer to rural origin environment.

Figure 5

Antibiotics with highest and lowest resistance (%) for E. coli, Enterococcus spp. and Klebsiella spp. in our study group. Antibiotic resistance was categorized into three categories: high—over 50% of tested strains showed resistance; intermediary—30 to 50% of tested strains exhibited resistance; and low antibiotic resistance—less than 30% of tested strains were resistant.

Figure 6

Antibiotic resistance comparison in patients with and without malformation. Green square—no malformation. Brown square-CAKUT.