The Emerging Resistance in Nosocomial Urinary Tract Infections: From the Pediatrics Perspective

Area of Science:

• Pediatric Infectious Diseases
• Antimicrobial Resistance
• Hospital-Acquired Infections

Background:

• Healthcare-associated infections (HAIs) increase mortality and healthcare costs.
• Limited data exists on etiologic agents and resistance patterns of HA-UTIs in pediatric intensive care units.
• Urinary tract infections (UTIs) are common HAIs in hospitalized children.

Purpose of the Study:

• To determine the distribution of pathogens causing HA-UTIs in pediatric patients.
• To analyze the antibiotic susceptibility patterns of these pathogens.
• To identify emerging resistance trends in pediatric HA-UTI cases.

Main Methods:

• Retrospective review of isolates from 138 children hospitalized in pediatric, neonatal, and pediatric surgery intensive care units.
• Identification of common bacterial species causing HA-UTI.
• Antimicrobial susceptibility testing, including carbapenem resistance and extended-spectrum beta-lactamase (ESBL) production.

Main Results:

• Klebsiella pneumoniae (34.1%) and Escherichia coli (26.8%) were the most common isolates.
• High resistance rates were observed in Pseudomonas aeruginosa: 46.2% to meropenem and 38.5% to imipenem.
• Extended-spectrum beta-lactamase (ESBL) production was prevalent in Klebsiella species (82.8%) and Escherichia coli (72.9%).
• Among ESBL-producing Klebsiella, resistance to meropenem/imipenem was 18.8% and ertapenem was 45.9%.
• Among ESBL-producing E. coli, resistance to meropenem/imipenem was 7.4% and ertapenem was 14.8%.

Conclusions:

• Emerging meropenem resistance in P. aeruginosa is a significant concern.
• High ertapenem resistance in ESBL-producing E. coli and Klebsiella species highlights the threat of multidrug-resistant organisms.
• These findings underscore the need for vigilant monitoring of superbug infections in pediatric HA-UTIs.