Related Experiment Video
Updated: Dec 23, 2025
Recurrent Escherichia coli Urinary Tract Infection Triggered by Gardnerella vaginalis Bladder Exposure in Mice
Published on: December 4, 2020
The changing resistance patterns of bacterial uropathogens in children
Eda Didem Kurt-Şükür1, Zeynep Birsin Özçakar1, Özlem Doğan2
1Departments of Division of Nephrology, Ankara University School of Medicine, Ankara, Turkey.
Insights
Antimicrobial resistance in pediatric urinary tract infections (UTIs) is a growing concern. This study found high resistance to ampicillin and co-trimoxazole, with notable extended-spectrum beta-lactamase (ESBL) positivity, especially in infants.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Antimicrobial Resistance
Background:
- Urinary tract infections (UTIs) pose management challenges due to increasing antimicrobial resistance.
- Understanding resistance patterns in pediatric UTIs is crucial for effective treatment.
Purpose of the Study:
- To assess antimicrobial resistance patterns of urinary isolates in children with UTI.
- To identify common uropathogens and their susceptibility profiles in pediatric patients.
Main Methods:
- Retrospective cohort study of 776 UTI episodes in 698 children (January 2017-January 2018).
- Isolates analyzed for susceptibility to various antimicrobials.
- Patients categorized into three age groups: ≤12 months, 13-60 months, and >60 months.
Main Results:
- Escherichia coli was the most common pathogen (83%), followed by Klebsiella pneumoniae (7.5%).
- High resistance rates observed for ampicillin (62.6%) and co-trimoxazole (39.8%).
- Overall extended-spectrum beta-lactamase (ESBL) positivity was 23.5%, with higher rates in infants (<1 year).
Conclusions:
- Ceftriaxone remains a viable empirical treatment option, but urine cultures are essential due to high ESBL rates.
- Infants (<1 year) require special consideration due to elevated resistance and ESBL positivity.
- Regular surveillance studies are necessary to monitor evolving uropathogen resistance patterns and guide treatment strategies.
Background:
Increased antimicrobial resistance is a problem in managing urinary tract infections (UTI). With this study we assessed the resistance patterns of urinary isolates in children with UTI between January 2017 and January 2018.
Methods:
A retrospective cohort study was conducted. Among 5,443 isolates, a total of 776 UTI episodes in 698 patients were included. Patients' gender, age, voiding dysfunction, UTI history, prophylaxis status, and presence of vesicoureteral reflux were noted. Patients were divided into three age groups: group 1 for ages ≤12 months; group 2 for ages 13-60 months; and group 3 for ages >60 months. The susceptibilities of etiologic agents to different antimicrobials were explored.
Results:
Median age was 54 months (range 1 month-21 years); male to female ratio was 1:5. The most common causative agent was Escherichia coli (83% of the cases), followed by Klebsiella pneumoniae (7.5%). Resistance to ampicillin (62.6%) and co-trimoxazole (39.8%) were remarkable in all isolates. Overall extended-spectrum beta-lactamase (ESBL) positivity was 23.5%. The highest resistance rates, higher ESBL positivity (28.6%), and K. pneumoniae frequency (13.5%) were observed in group 1. Ceftriaxone resistance was significantly low (0.5%) in the ESBL (-) group, which constituted the majority of the isolates. Higher resistance rates were observed among the patients on prophylaxis compared to those off prophylaxis (P < 0.001).
Conclusion:
Ceftriaxone can still be used for empirical treatment; however, initial urine culture results are crucial due to high ESBL positivity. Special consideration must be taken for patients under 1 year of age. Periodical surveillance studies are needed to explore the changing resistance patterns of uropathogens and modify treatment plans.
More Related Videos
Related Concept Videos
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:25Urinary Tract Infection II: Pathophysiology
01:30Development of Antibiotic Resistance
01:31Defense Against Bacterial Pathogens
Phagocytes
Phagocytes are the frontline soldiers of the immune system. They include neutrophils and macrophages. Neutrophils are the most abundant type of white blood cell and are quickly mobilized to the site of infection. Macrophages are larger cells that patrol...
01:26Urinary Tract Infection I: Introduction
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care