Prospective study of clinical, microbiological and antibiotic sensitivity profile of community-acquired paediatric culture-positive urinary tract infection in a tertiary care hospital in central Kerala

Background: Childhood urinary tract infections (UTIs) require early diagnosis and treatment to prevent recurrence and renal scarring. A local antibiogram is crucial for selecting empiric antibiotic treatment until culture reports are available. This study analyzed the clinical presentation, organism spectrum, and antimicrobial sensitivity in pediatric UTIs, including multidrug-resistant extended-spectrum beta-lactamase (MDR ESBL) occurrence, in a central Kerala tertiary care hospital. Methods: This prospective study included 93 culture-positive pediatric UTI cases from children aged one month to 16 years. We analyzed clinical presentations, organism spectrum, and antimicrobial sensitivity in two age groups: under 5 years and 5 years and older. Data were statistically analyzed using appropriate methods. Results: Of the 93 cases, 83.9% were in the 1 month to <5 years group, and 16.1% were in the 5 to 16 years group. Fever was present in 90.3%, dysuria in 26.88%, and increased frequency of micturition in 9.6%. E. coli was the most common organism (58.1%), particularly in the younger group. Non-E. coli organisms predominated in the older group. Sensitivity rates were 93.5% for amikacin, 84.9% for piperacillin-tazobactam, and 90.3% for meropenem. MDR ESBL prevalence was similar in both age groups (43.6%). Conclusions: UTIs are more common in children under 5 years, with E. coli being the predominant cause. In children over 5 years, non-E. coli organisms are more frequent. Amikacin is the preferred first-line IV antibiotic, followed by piperacillin-tazobactam and meropenem. Amoxyclav is recommended for oral treatment, except in cases involving non-E. coli in children over 5 years.