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Changes in Antimicrobial Resistance in Pediatric Urinary Pathogens Before, During, and After the COVID-19 Pandemic

Seon Hee Lim1, Kyo Jin Jo1, Shin Yun Byun1

  • 1Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea.

Antibiotics (Basel, Switzerland)
|December 30, 2025
PubMed

Insights

Pediatric urinary tract infections (UTIs) saw increased ciprofloxacin resistance during the COVID-19 pandemic, particularly in infants. This trend persisted post-pandemic, underscoring the need for better antibiotic stewardship.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance (AMR)
  • Epidemiology

Background:

  • Pediatric urinary tract infections (UTIs) pose treatment challenges due to rising antimicrobial resistance (AMR).
  • The COVID-19 pandemic influenced antibiotic prescribing patterns in children, but its effect on AMR trends was unclear.
  • Investigating AMR trends in young children hospitalized with febrile UTI during different pandemic phases is crucial.

Purpose of the Study:

  • To analyze antimicrobial resistance (AMR) trends in urinary pathogens from children under 24 months hospitalized with febrile UTI.
  • To compare AMR patterns during the pre-, during-, and post-COVID-19 pandemic periods.
  • To identify predictors of ciprofloxacin nonsusceptibility in pediatric febrile UTI.

Main Methods:

  • Retrospective study of children aged <24 months hospitalized for first febrile UTI (2008-2023).
  • Stratification by age (<100 days vs. 100 days-24 months) and pandemic period (pre-, during-, post-COVID-19).
  • Interrupted time-series (ITS) analysis and logistic regression to assess trends and predictors of ciprofloxacin nonsusceptibility.

Main Results:

  • Ciprofloxacin susceptibility significantly decreased during the COVID-19 pandemic, especially in infants <100 days.
  • ITS analysis revealed an immediate 12.1% increase in ciprofloxacin nonsusceptibility at pandemic onset, which continued.
  • Extended-spectrum β-lactamase (ESBL) production was the strongest predictor of ciprofloxacin resistance.

Conclusions:

  • The study indicates a significant rise in ciprofloxacin nonsusceptibility in pediatric febrile UTI during the COVID-19 pandemic.
  • Adult antibiotic use and clonal spread may drive AMR persistence and dissemination.
  • Integrated antibiotic stewardship and genomic surveillance are essential for combating pediatric AMR.
Abstract

Keywords:
COVID-19antimicrobial resistanceciprofloxacinextended-spectrum β-lactamaseinterrupted time-seriespediatric UTI

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