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Etiology and Antimicrobial Susceptibility Pattern of Urinary Tract Infection in the First Year after Pediatric Renal
Shirin Sayyahfar1, Zahra Mohammadnezhad2, Khosrow Zamani3
1Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Insights
Urinary tract infections (UTIs) are common in pediatric kidney transplant patients, with multidrug-resistant bacteria posing a significant challenge. This study highlights increasing antibiotic resistance, suggesting changes in empirical treatment for UTIs in this population.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) are a frequent complication following pediatric renal transplantation.
- The rise of multidrug-resistant (MDR) bacteria in UTIs presents a critical therapeutic hurdle in this vulnerable patient group.
- Understanding UTI prevalence and antimicrobial susceptibility is vital for optimizing post-transplant care in children.
Purpose of the Study:
- To investigate the frequency of UTIs in pediatric renal transplant recipients within the first year post-transplant.
- To identify the primary etiological agents responsible for UTIs in this cohort.
- To determine the antibiotic susceptibility patterns of isolated pathogens to guide treatment strategies.
Main Methods:
- A retrospective cohort study was conducted involving 81 pediatric renal transplant recipients.
- Data on confirmed UTI episodes within the first year post-transplantation were collected and analyzed.
- Antibiotic resistance patterns of isolated UTI pathogens were determined using standard microbiological techniques.
Main Results:
- The most common bacterial isolates causing UTIs were Escherichia coli (31.2%), Pseudomonas aeruginosa (25%), Enterococci (21.9%), and Klebsiella pneumoniae (12.5%).
- High resistance rates were observed for trimethoprim/sulfamethoxazole (TMP/SMX), cephalosporins, and fluoroquinolones among Gram-negative bacteria.
- Enterococci isolates showed no resistance to linezolid and nitrofurantoin.
Conclusions:
- Antibiotic resistance is a growing concern for pathogens causing UTIs in pediatric renal transplant recipients.
- Empirical use of TMP/SMX and third-generation cephalosporins for UTIs in this population should be reconsidered.
- Ciprofloxacin should be used cautiously due to increasing resistance trends.
Abstract:
Background: Urinary tract infection (UTI) is common after pediatric renal transplantation, and the emergence of multidrug-resistant (MDR) bacteria causing UTI is a therapeutic challenge in this regard. The main purpose of this study was to determine the UTI frequency, its etiologic agents, and the antibiotic susceptibility pattern in the first year following renal transplantation in Iranian pediatric recipients. Methods: In a retrospective cohort study, all of the 81 children who had undergone renal transplantation in Hazrat Rasoul Akram Hospital between 2012 and 2017 were enrolled. Confirmed episodes of UTI during the first year following renal transplantation were analyzed. The pattern of antibiotic resistance was determined for the causative agents of UTI. The data were analyzed using the IBM SPSS Statistics software (version 20). and the P < 0.05 was considered significant. Results: Totally, from 81 enrolled cases, 37(44.7%) cases were in the age group of 11-15 years. Overall, 19, 10, and 3 UTI episodes had occurred in the first month, from the first to sixth month, and between the sixth month and one year after transplantation, respectively. The four most common isolated bacteria were Escherichia coli (E. coli; 31.2%), Pseudomonas aeruginosa (P. aeruginosa; 25%), Enterococci (21.9%) and Klebsiella pneumoniae (K. pneumoniae; 12.5%). The highest rate of resistance was reported to trimethoprim/sulfamethoxazole (TMP/SMX), cephalosporins, and fluoroquinolones among gram-negative bacteria. However, none of the Enterococci isolates were resistant to linezolid and nitrofurantoin. Conclusion: Resistance to antibiotics is increasing among the pathogens causing UTI in pediatric renal transplanted cases. It is suggested to stop the administration of TMP/SMX and third-generation cephalosporins for empiric treatment of UTI in Iranian pediatric renal transplant recipients. Ciprofloxacin might be administered cautiously secondary to the increasing rate of antibiotic resistance in this group.
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