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Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies
Raluca Isac1,2, Diana-Georgiana Basaca2, Ioana-Cristina Olariu1,2
1IIIrd Pediatric Clinic, Department of Pediatrics, "Victor Babeș" University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania.
Insights
Urinary tract infections (UTI) in children with congenital anomalies of the kidney and urinary tract (CAKUT) show high antibiotic resistance. Understanding local resistance patterns is crucial for effective treatment recommendations in Romania.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Urinary tract infections (UTIs) are prevalent globally in pediatric populations.
- Congenital anomalies of the kidney and urinary tract (CAKUT) are significant risk factors for recurrent UTIs and the development of antibiotic resistance.
- Antibiotic resistance poses a critical public health challenge worldwide, necessitating localized surveillance.
Purpose of the Study:
- To investigate the antibiotic resistance patterns of uropathogens in children diagnosed with CAKUT and experiencing UTIs.
- To analyze local trends in antibiotic resistance in western Romania.
Main Methods:
- A retrospective study was conducted on 252 children with CAKUT over five years.
- Data from 91 children with 260 UTI episodes were analyzed, including demographics, CAKUT details, UTI history, uropathogen types, and antibiotic susceptibility.
- Bacterial identification and antibiotic resistance profiling were performed.
Main Results:
- Escherichia coli was the most common uropathogen (38.84%), followed by Klebsiella spp. (21.15%) and Enterococcus spp. (15.76%).
- High resistance rates were observed for ampicillin, amoxicillin, and second-generation cephalosporins.
- Pseudomonas spp. showed susceptibility to amikacin, quinolones, and colistin, while vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam were effective against Gram-positive UTIs.
Conclusions:
- Significant antibiotic resistance to commonly prescribed antibiotics was identified in pediatric UTIs associated with CAKUT.
- Certain broad-spectrum antibiotics demonstrated lower resistance rates.
- Local surveillance of uropathogen antibiotic resistance is essential for guiding empirical treatment strategies and international guideline adherence.
Abstract:
Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens' antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities.
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