Bacterial etiology and antimicrobial resistance patterns of pediatric UTIs in the West bank, Palestine: a cross-sectional study

Urinary tract infections (UTIs) are among the most common bacterial infections in children. This study aimed to investigate the distribution of bacterial uropathogens and their antimicrobial resistance patterns among hospitalized pediatric patients with UTIs in governmental hospitals across the West Bank, Palestine. The findings are intended to support evidence-based empirical treatment strategies and inform local antimicrobial stewardship efforts. This is a cross-sectional study, analyzed urine culture results from pediatric patients with UTI symptoms admitted to governmental hospitals across three regions of the West Bank in 2021–2022, using data from the Ministry of Health’s electronic database. 3,949 positive urine culture results were analyzed; 58.5% of the total were aged ≥ 2 years, and 2883 were females (73%), with Gram-negative bacteria accounting for 87.1%. The most common pathogen was Escherichia coli (61.7%). The prevalence of multidrug-resistant (MDR) bacteria was 34.3%. Among Gram-negative isolates, 34.5% were MDR, 33.1% were extended-spectrum beta-lactamase (ESBL) producers, and 3.3% were carbapenem-resistant Enterobacterales (CRE). The highest MDR percentage was in Proteus spp. (50.6%) followed by Klebsiella spp. (45.4%), and E. coli (32.6%). According to matching with the empirical antibiotics, Ampicillin shows 16.8%, Ceftriaxone shows 49.5%, and Cefotaxime shows 51.9%. Our findings highlight the high prevalence of MDR bacteria among pediatric UTI patients in the West Bank. E. coli and Klebsiella spp. were the predominant pathogens, showing considerable resistance to commonly used antibiotics. These results underscore the need to reassess empirical UTI treatment regimens, conduct routine antibiogram monitoring, and implement coordinated infection control and antibiotic stewardship programs across the West Bank, Palestine.