Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies of Kidney and Urinary Tract

Abstract

Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens’ antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities.

Urinary Tract Infection and Antimicrobial Resistance Patterns: 5-Year Experience in a Tertiary Pediatric Nephrology Center in the Southwestern Region of Poland

“…The most common causative agents for a UTI in our study were E. coli and other enteric bacteria, such as Klebsiella spp., Proteus spp., Enterococcus spp., and Enterobacter spp., which is in line with previous observations [1,4,12,14]. Our study confirmed that children with CAKUT and a neurogenic bladder are particular groups of patients prone to UTIs caused by non-E. coli bacteria and uropathogens characterized by higher rates of resistance to different antibiotics [1,3,4,12,[14][15][16][17]. Nevertheless, the most common causative agent for a UTI in children with CAKUT is E. coli [15,18].…”

Analysis of bacterial flora of urinary tract infection in hospitalized children with and without congenital urinary tract malformations

“…In the UTI-CAKUT population assessed by Isac et al in about 39% of cases Escherichia coli was isolated from urine, which was in 14.9% of cases resistant to ceftazidime and in 13.2% to nitrofurantoin, which is in line with our result. The authors also reported that Escherichia coli was resistant to amoxicillin/clavulanic acid in 38.5% of cases, to ampicillin in 72.3% of cases and trimethoprim-sulfamethoxazole in 56% of cases [12].…”

A Pilot Comparative Study between Creatinine- and Cystatin-C-Based Equations to Estimate GFR and Kidney Ultrasound Percentiles in Children with Congenital Anomalies of the Kidney and Urinary Tract

“…Congenital anomalies affecting the kidneys and urinary tract (CAKUT) represent a significant challenge in pediatric nephrology, demanding thorough and precise methods for assessing renal function and guiding therapeutic interventions [1,2]. Among the arsenal of diagnostic tools available, the bedside Schwartz equation, cystatin C clearance, and kidney ultrasound percentiles have emerged as prominent contenders, each offering distinct advantages and considerations in the evaluation of renal health in children with congenital anomalies [3][4][5].…”