Predictors of Antimicrobial Resistance among Pathogens Causing Urinary Tract Infection in Children

Area of Science:

• Pediatrics
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Urinary tract infections (UTIs) are common in children.
• Identifying risk factors for antimicrobial resistance is crucial for effective treatment.
• Narrow-spectrum antimicrobials are often preferred for UTIs, but resistance is a growing concern.

Purpose of the Study:

• To identify demographic and clinical factors associated with resistance to narrow-spectrum antimicrobials in children with UTIs.
• To inform treatment guidelines and reduce the incidence of resistant UTIs in pediatric populations.

Main Methods:

• Analysis of data from 769 children (ages 2-71 months) from the Randomized Intervention for Children with Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation studies.
• Logistic regression models were used to assess associations between patient characteristics and antimicrobial resistance.
• Key factors examined included sex, circumcision status, presence of vesicoureteral reflux, bladder bowel dysfunction, and recent antibiotic exposure.

Main Results:

• Uncircumcised males had approximately 3 times the risk of resistance compared to females (OR 3.1).
• Children with bladder bowel dysfunction showed 2 times the risk of resistance (OR 2.2).
• Recent antibiotic use (1 course in 6 months) increased the odds of resistance (OR 1.6), as did Hispanic ethnicity.

Conclusions:

• Uncircumcised males, Hispanic children, and those with bladder bowel dysfunction are at higher risk for UTIs caused by resistant pathogens.
• Children who received recent antibiotic therapy are also more likely to harbor resistant organisms.
• These findings highlight specific pediatric groups requiring careful consideration for antimicrobial selection in UTI management.