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Urinary tract infections in children: clinical and antimicrobial resistance data from Bucharest area, Romania
Victor Daniel Miron1, Claudiu Filimon2, Teodor Cabel2
1MD, PhD student, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; National Institute for Mother and Child Health "Alessandrescu-Rusescu", Bd. Lacul Tei 120, 020395, Bucharest, Romania.
Insights
Urinary tract infections (UTIs) in children are common, with high rates of antibiotic resistance observed in Romania. This study highlights the need for updated treatment guidelines based on real-world resistance patterns.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Clinical pharmacy
Background:
- Urinary tract infections (UTIs) represent a significant bacterial disease burden in pediatric populations, particularly affecting infants and young children.
- The frequency and characteristics of childhood UTIs necessitate ongoing surveillance and analysis.
Purpose of the Study:
- To analyze the clinical features, laboratory findings, and antimicrobial resistance patterns of uropathogens causing UTIs in children.
- To provide real-world data for updating empirical treatment recommendations for pediatric UTIs in Romania.
Main Methods:
- A retrospective study was conducted on 264 children diagnosed with UTI between January 2017 and December 2019.
- Data collected included clinical characteristics, laboratory parameters, and antimicrobial susceptibility testing of isolated uropathogens.
Main Results:
- Females and infants comprised the majority of cases. The recurrence rate was 27.7%, associated with renal malformations.
- E. coli was the predominant pathogen (80.3%). Significant antimicrobial resistance was observed against commonly prescribed antibiotics like ampicillin and trimethoprim/sulfamethoxazole.
- Hospitalization was linked to younger age, elevated leukocytes, neutrophils, and C-reactive protein levels.
Conclusions:
- A high prevalence of antimicrobial resistance among pediatric uropathogens was identified.
- Real-world antimicrobial resistance data is crucial for guiding and updating empirical treatment strategies for pediatric UTIs.
- Further extensive studies are required in Romania and globally to monitor uropathogen resistance trends in both pediatric and adult populations.
Introduction:
Urinary tract infections (UTIs) are among the most common bacterial diseases of childhood with an increased frequency in infants and young children.
Methods:
We conducted a retrospective study of children diagnosed with UTI in the Alessandrescu-Rusescu National Institute for Mother and Child Health, Bucharest, Romania between January 2017 and December 2019. We evaluated the patients' clinical characteristics, laboratory parameters and the resistance profile of the identified uropathogens.
Results:
A total of 264 children were included in the analysis. Females (71.6%, n=186) and infants (52.7%, n=139) were more commonly affected. The recurrence rate was 27.7% and was positively associated with the presence of renal malformations. Age under 1-year, increased leukocyte and neutrophil counts, and elevated C-reactive protein were associated with hospitalization. E. coli (80.3%, n=212) was the main etiological agent isolated, followed by Proteus mirabilis (9.8%, n=26) and Klebsiella spp. (6.4%, n=17). We identified increased resistance for all germs to common antibiotics used in pediatrics: ampicillin, amoxicillin/clavulanate, cefuroxime, ceftriaxone, and trimethoprim/sulfamethoxazole.
Conclusions:
We identified an increased resistance of uropathogens to antimicrobials commonly used in children. Reporting antimicrobial resistance from real-world clinical practice is necessary for accurate mapping and continuous updating of initial treatment recommendations until antibiogram results are received. In Romania and other countries, extensive studies are needed to follow up uropathogen resistance in both children and adults.
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