Related Experiment Video
Updated: Jun 10, 2026
An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
Resistance pattern of breakthrough urinary tract infections in children on antibiotic prophylaxis
Ali Reza Nateghian1, Joan L Robinson, Shahab Mohandessi
1Pediatric Infectious Diseases Department, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran.
Insights
Prophylactic antibiotics for pediatric urinary tract infections (UTIs) showed varying resistance patterns. The choice of antibiotic prophylaxis impacts the organisms and resistance observed in breakthrough UTIs.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Prophylactic antibiotics are standard for preventing urinary tract infections (UTIs) in children.
- The impact of different prophylactic antibiotics on the resistance patterns of breakthrough UTIs is not well-established.
Purpose of the Study:
- To investigate if the choice of antimicrobial prophylaxis influences the organisms and resistance patterns of breakthrough UTIs in children.
- To compare the resistance incidence among different prophylactic antibiotics used for UTIs.
Main Methods:
- Retrospective descriptive study of breakthrough UTIs in children (age > 1 month) receiving continuous antibiotic prophylaxis.
- Data collected from 2000 to 2006 at a referral children's hospital in Tehran, Iran.
- Analysis of causative organisms and their antibiotic resistance patterns relative to the prophylactic agent.
Main Results:
- Escherichia coli was the most common pathogen in breakthrough UTIs, regardless of prophylaxis.
- 59% of breakthrough UTIs were caused by organisms resistant to the prescribed prophylactic antibiotic.
- Higher resistance rates were observed with cefixime (78%) compared to cephalexin (37%) and trimethoprim-sulfamethoxazole (37%).
Conclusions:
- The resistance patterns of pathogens causing breakthrough UTIs in children vary significantly based on the chosen prophylactic antibiotic.
- Antimicrobial resistance should be considered when selecting empiric therapy for breakthrough UTIs in children on prophylaxis.
Abstract:
Prophylactic antibiotics are commonly used for prevention of urinary tract infections (UTIs) in children. It was postulated that the organisms and resistance patterns of breakthrough infections would differ with the choice of antimicrobial prophylaxis. This was a retrospective descriptive study of all breakthroughs UTI from 2000 to 2006 in children over 1 month of age discharged from a referral children's hospital in Tehran, Iran on continuous antibiotic prophylaxis for UTIs. Fifty-seven children discharged on prophylaxis had breakthrough UTIs of which 32 (56%) had a previously diagnosed urinary tract anomaly. Escherichia coli was responsible for the majority of infections irrespective of choice of prophylaxis. Thirty-three of 56 breakthrough UTIs (59%) were with organisms that were resistant to the prophylactic antibiotic. There was an increased incidence of resistance to prophylaxis in children on cefixime (16 of 22; 78%) when compared with children on cephalexin (7 of 19; 37%; p=0.02) and a trend toward increased resistance when compared with children on trimethoprim-sulfamethoxasole (3 of 8; 37%) (p=0.10). In conclusion, the resistance pattern of organisms causing breakthrough UTIs varies with the choice of prophylaxis which should be taken into consideration in chosing empiric therapy for such infections.
Related Concept Videos
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:25Mechanism of Antibiotic Resistance in MRSA
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:25Urinary Tract Infection II: Pathophysiology
01:17Urinary Tract Infection IV: Nursing Management
01:28Acute Pyelonephritis II: Diagnostic Studies and Management