Antibiotic Resistance Trends of Uropathogens in Community-acquired Urinary Tract Infection in Children: A Single-center Retrospective Study

Aim and background: Urinary tract infections (UTI) are among the most common infections requiring antibiotics in the pediatric population.There have been reports of increasing resistance of uropathogens to the common antibiotics used in UTI.Guidelines by the Indian Society of Pediatric Nephrology recommend third-generation cephalosporins, aminoglycosides, amoxicillin-clavulanate, or quinolones as first-line treatment for UTI.We aimed to evaluate the resistance pattern of the uropathogens isolated from patients with community-acquired UTI against the first-line antibiotics recommended for treatment.The secondary objective was to analyze whether there was an increase in resistance between the two halves of the study period.Materials and methods: A retrospective analysis was conducted among pediatric inpatients with a diagnosis of UTI and a positive urine culture during the period from January 2009 to December 2019 in a tertiary care hospital in South India.Details of their urine culture with the resistance pattern were analyzed.A comparison of the resistance pattern was made between the first and second halves of the study period.Results: Among 245 patients who met the inclusion criteria, the predominant organism isolated was E. coli, which constituted 64.5%, followed by Klebsiella (17%).E. coli showed 70% resistance to ceftriaxone, 56% to co-trimoxazole, and 53% to quinolones.Similarly, Klebsiella also showed 66.4% resistance to ceftriaxone, 51.9% to co-trimoxazole, and 10% to ofloxacin.The overall rate of extended spectrum beta-lactamase (ESBL) producers among Enterobacterales was 65.2%.A significant increase in resistance was noted among Enterobacterales to piperacillin-tazobactam, cefoperazone-sulbactam, and amikacin between the two study periods.Conclusion: Uropathogens causing community-acquired UTI in children are increasingly becoming resistant to the common first-line antibiotics recommended for their treatment.Clinical significance: With nearly two-thirds of the common uropathogens isolated in community-acquired UTI being ESBL producers, treatment recommendations should be revisited.Antibiotic stewardship measures in primary care should be strengthened.