Antibiotic Resistance Trends in Recurrent Paediatric Urinary Tract Infections: A Five-Year Single-Centre Experience

Area of Science:

• Pediatric Infectious Diseases
• Clinical Microbiology
• Antimicrobial Stewardship

Background:

• Recurrent urinary tract infections (rUTIs) in children present challenges due to rising antimicrobial resistance.
• Limited treatment options and difficulties in prophylactic management necessitate local resistance monitoring.
• Evidence-based antimicrobial stewardship requires continuous surveillance of resistance trends.

Purpose of the Study:

• To analyze trends in multidrug resistance (MDR) and extended-spectrum beta-lactamase (ESBL) producing organisms in pediatric rUTIs.
• To identify clinical factors associated with MDR in children with rUTIs.
• To assess the temporal stability of MDR and ESBL rates over a five-year period.

Main Methods:

• Retrospective analysis of pediatric rUTI cases (2020-2024) using ICD-10 code N39.0.
• Inclusion of demographic, clinical, and microbiological data, with antimicrobial susceptibility testing.
• Statistical analysis including logistic regression and Cochran-Armitage trend test to evaluate MDR predictors and temporal trends.

Main Results:

• Multidrug resistance (MDR) was observed in 48.5% of isolates, and ESBL production in 20.9%.
• MDR was significantly associated with urinary tract malformations and continuous antibiotic prophylaxis.
• No significant temporal increase in MDR rates was detected over the study period.

Conclusions:

• MDR and ESBL rates in pediatric rUTIs remain high but have stabilized.
• The study confirms the absence of a significant upward trend in resistance.
• Continuous surveillance and stewardship are vital to preserve antibiotic efficacy in pediatric rUTI management.