Pediatric urinary tract infection and prevalence of antibiotics resistance – A retrospective study in the Qassim region

Objective: This study aimed to evaluate the prevalence of uropathogens and their antibiotic resistance patterns in community-acquired urinary tract infections (UTIs) among children in the Qassim region. Methods: A retrospective review of electronic medical records was conducted for pediatric patients aged 0–14 years with positive urine cultures from January 2021 to December 2023. Inclusion criteria included bacterial counts exceeding 10,000 colony-forming units (CFU)/mL from catheter samples or 100,000 CFU/mL from midstream urine. Patients with hospital-acquired UTIs or mixed cultures were excluded. Antibiotic susceptibility was tested using VITEK AST CARDS. Results: Out of 192 pediatric patients with UTIs, the majority (66.7%) were female. The highest prevalence of infection was observed in children aged 2–8 years (49%), followed by infants under 1 (30.2%) year. Escherichia coli emerged as the most common uropathogen, particularly in females aged 2–8 (70.4%) years, while Klebsiella was more prevalent in younger males, especially infants. Antibiotic susceptibility testing revealed high resistance to commonly prescribed antibiotics. E. coli showed high resistance to ampicillin (64.9%) and trimethoprim-sulfamethoxazole (50%), while Klebsiella exhibited resistance to ampicillin (73.5%) and amoxicillin-clavulanic acid (58.8%). In contrast, both pathogens demonstrated lower resistance rates to cefepime, piperacillin-tazobactam, and meropenem. In addition, 17.2% of all isolates were identified as extended-spectrum beta-lactamase producers, posing further challenges to effective treatment. Conclusion: Significant resistance was observed among E. coli and Klebsiella to commonly used antibiotics. The presence of extended-spectrum beta-lactamase-producing organisms highlights the need for targeted antibiotic stewardship and region-specific protocols to manage pediatric UTIs effectively.