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Bacteremia and antimicrobial resistance pattern of uropathogens causing febrile urinary tract infection in a
Hassan Heshmat1, Marwa Meheissen2, Ahmed Farid3
1MD, PhD, Department of Pediatrics, Faculty of Medicine Alexandria University, Postal code: 21526, Egypt.
Insights
Febrile urinary tract infections (UTIs) in children can lead to severe complications. This study found high rates of bacteremia and multidrug-resistant organisms, highlighting the need for appropriate empiric antibiotic therapy.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Febrile urinary tract infections (UTIs) in children pose a significant risk for kidney damage.
- Concomitant bacteremia occurs in 8-10% of pediatric UTI cases.
- Effective treatment is crucial to prevent long-term sequelae like kidney scarring.
Purpose of the Study:
- To determine the prevalence of UTI-associated bacteremia in children.
- To identify common bacterial pathogens causing UTIs.
- To analyze antimicrobial susceptibility patterns for guiding empiric therapy.
Main Methods:
- Prospective study over 6 months at Alexandria University Children's Hospital.
- Collected blood and urine samples for culture and antimicrobial susceptibility testing.
- Included 103 children diagnosed with febrile UTIs.
Main Results:
- Bacteremia was present in 63.1% of children with febrile UTIs.
- The most common pathogens were *E. coli* (49.5%) and *Klebsiella pneumoniae* (29.1%).
- A high prevalence of multidrug-resistant (MDR) organisms (66%) was observed.
Conclusions:
- *E. coli* remains a primary cause of pediatric UTIs.
- Ceftriaxone and gentamicin demonstrate good susceptibility and are recommended empiric options.
- Urgent attention to antimicrobial resistance patterns is vital for effective UTI management.
Introduction:
Febrile urinary tract infections (UTIs) in children are among the most serious bacterial infections. Inadequate treatment can lead to kidney scarring and permanent kidney damage. Eight to ten percent of children with UTIs could have concomitant bacteremia. The study aimed to estimate the prevalence of UTI-associated bacteremia and identify common organisms causing UTIs and their antimicrobial susceptibility patterns to help guide empiric antimicrobial therapy.
Methods:
The current study was conducted over a 6-month period on children admitted with febrile UTIs at Alexandria University Children's Hospital. Blood and urine samples were collected for culture and antimicrobial susceptibility.
Results:
A total of 103 children with a median age of 12 months (IQR 6.0-24.0) were included in the study. Concomitant bacteremia was present in 63.1% (n=65). The median temperature of 38.40°C (IQR 38.15-38.60) and the median creatinine level of 0.18 mg/dL (IQR 0.14-0.25) were significantly higher in the bacteremic group compared to the non-bacteremic group (p=0.005, p=0.034, respectively). E. coli (n=51; 49.5%) and Klebsiella pneumoniae (n=30; 29.1%) were the most common isolated organisms. Most (n=68; 66%) of the isolated organisms were multidrug-resistant (MDR), followed by extensively drug-resistant (XDR) (n=16; 15.5%), and pan-drug-resistant (PDR) organisms (n=1; 1%). E. coli showed lower resistance to gentamicin and ceftriaxone (9.8 % and 13.7%, respectively).
Conclusions:
E. coli remains the most important UTI pathogen. Ceftriaxone and gentamicin are good empiric options for febrile UTIs in our hospital.
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