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Antimicrobial Resistance in Pediatric UTIs with Congenital Urogenital Anomalies: An 11-Year Saudi Retrospective Study

Fuad Alanazi1, Basmah M Almaarik1

  • 1Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia.

Antibiotics (Basel, Switzerland)
|May 27, 2026
PubMed

Insights

Children with congenital urogenital anomalies (CUA) frequently experience urinary tract infections (UTIs) with high resistance to common antibiotics. Carbapenems and aminoglycosides remain effective, guiding empiric treatment for this vulnerable pediatric group.

Area of Science:

  • Pediatric Infectious Diseases
  • Urology
  • Clinical Microbiology

Background:

  • Children with congenital urogenital anomalies (CUA) are at increased risk for recurrent urinary tract infections (UTIs).
  • Recurrent UTIs and antibiotic exposure in this population can lead to the emergence of resistant uropathogens.
  • Characterizing local resistance patterns is crucial for effective management.

Purpose of the Study:

  • To determine the distribution of uropathogens causing UTIs in pediatric patients with CUA.
  • To analyze antimicrobial resistance patterns, including multidrug resistance (MDR), in this cohort.
  • To inform empiric antibiotic therapy recommendations for UTIs in children with CUA.

Main Methods:

  • Retrospective cohort study of pediatric patients (<18 years) with CUA and positive urine cultures.
  • Data collected from King Khalid University Hospital, Riyadh, between 2015-2025.
  • Uropathogen identification and antimicrobial susceptibility testing (AST) data analyzed; MDR defined by Magiorakos criteria.

Main Results:

  • *Escherichia coli* (37.2%) and *Klebsiella pneumoniae* (23.8%) were the most common uropathogens.
  • High resistance rates observed for ampicillin (83.6%), trimethoprim-sulfamethoxazole (54.2%), and cephalosporins.
  • Carbapenems (>90% susceptibility) and aminoglycosides (>90% susceptibility) showed favorable in vitro activity.
  • Overall MDR prevalence was 35.5%, with higher rates in *Klebsiella oxytoca* (57.1%) and *Escherichia coli* (47.6%).

Conclusions:

  • Pediatric patients with CUA exhibit significant resistance to first-line antibiotics for UTIs.
  • Carbapenems and aminoglycosides demonstrate retained susceptibility and are potential options for empiric treatment.
  • Continuous local surveillance of antimicrobial resistance is essential for optimizing treatment strategies in this high-risk population.
Abstract

Keywords:
Escherichia coliantimicrobial resistancecongenital urogenital anomaliesmultidrug resistancepediatricsurinary tract infection

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