Pediatric Urinary Tract Infection Research Articles

Spontaneous Resolution or Antibiotic Effectiveness? Reflection on a Case of Pediatric Urinary Tract Infections Caused by Enterococcus Raffinosus.

Spontaneous Resolution or Antibiotic Effectiveness? Reflection on a Case of Pediatric Urinary Tract Infections Caused by Enterococcus Raffinosus.

Screening of Asymptomatic Urinary Tract Infection among School Childrens through Dipstick and Microscopic Examination

Background: Urinary tract infections (UTI) are among the most prevalent pediatric infectious diseases, leading to substantial healthcare utilization including hospitalization and antibiotic therapy. Despite the asymptomatic nature of many pediatric UTIs, these infections can contribute to significant morbidity if left undiagnosed and untreated, including the development of chronic kidney disease. Objective: This study aimed to assess the prevalence of asymptomatic UTIs in school-going children and to evaluate the effectiveness of dipstick and microscopic urinalysis as diagnostic tools. Methods: A cross-sectional study was conducted with 67 asymptomatic school-aged children in the district of Nowshera, KP. Urine samples were analyzed using urine dipstick tests followed by microscopic examination to detect the presence of pyuria, hematuria, and proteinuria. The study excluded children previously diagnosed with UTI or any other infectious disease. SPSS version 25 was utilized for data analysis, with results presented in descriptive statistics. Results: Of the total children screened, 40 (59.7%) were male, and 27 (40.3%) were female. Age distribution was split between 3 to 7 years (25.4%) and 8 to 15 years (74.6%). The dipstick and microscopic examinations revealed UTI positivity in 46 children (68.7%). Specifically, pyuria was detected in 32.83%, hematuria in 32.83%, and proteinuria in 18% of the screened children. Conclusion: The study highlights the high prevalence of asymptomatic UTIs among school children and emphasizes the necessity for routine urine examinations as an integral component of pediatric healthcare to prevent future complications. Furthermore, dipstick and microscopic analyses were validated as efficient diagnostic tools for early detection of UTIs.

Prevalent Bacterial Etiologies of Urinary Tract Infections in Febrile Children Under Five Years of at Federal Medical Centre, Owerri, Imo State, Nigeria

Urinary Tract Infections (UTIs) in children under five years old pose a significant health concern, influenced by various factors like bacterial agents, anatomy, immunity, and genetics. The study aimed to identify prevalent bacterial causes of UTIs in febrile children under five at a medical center in Nigeria. Among 170 participants, E. coli was the most frequently isolated bacteria (37.5%), followed by Klebsiella spp (18.8%) and Staphylococcus aureus (15.6%). The research underscores E. coli as the primary uropathogen, aligning with global trends, while acknowledging local variations in UTI causative agents. Keywords: Urinary Tract Infections, Febrile Children, Bacterial Etiologies and Pediatric UTI.

POLA KEPEKAAN ANTIBIOTIK ORAL PADA INFEKSI SALURAN KEMIH KOMUNITAS PADA PASIEN PEDIATRIK RS X TAHUN 2022

Some pediatric urinary tract infection show unspesific symptoms and can be treated as an outpatient. Right oral antibiotic can prevent those infection become more severe. All urin sample from pediatic patient without history of antibiotic before sample were taken were collected for one year to get antibiotic pattern from oral antibiotic such as amoxicillin, amoxicillin clavulanat, cefixime, cotrimoxazole, and fosfomycin from all pathogen. All pediatric patient were classified by age. From 0-1 year group dan 1-3 years old group, Proteus mirabilis, Eschericia coli and Enterococcus sp. are the most common bacteria found while oral antibiotic with highest sentivity are cotrimoxazole and fosfomycin. Most Multi Drug Resistant bacteria found in this study were from 0-1 year old group

Shorter versus longer-course of antibiotic therapy for urinary tract infections in pediatric population: an updated meta-analysis.

Urinary tract infections (UTI) affect between 3% to 7.5% of the febrile pediatric population each year, being one of the most common bacterial infections in pediatrics. Nevertheless, there is no consensus in the medical literature regarding the duration of per oral (p.o.) antibiotic therapy for UTI among these patients. Therefore, our meta-analysis aims to assess the most effective therapy length in this scenario. PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing short (≤ 5days) with long-course (≥ 7days) per os (p.o.) antibiotic therapy for children with UTI. Statistical analysis was performed using R Studio version 4.2.1, heterogeneity was assessed with I2 statistics, and the risk of bias was evaluated using the RoB-2 tool. Risk Ratios (RR) with p < 0.05 were considered statistically significant. Seventeen studies involving 1666 pediatric patients were included. Of these, 890 patients (53.4%) were randomized to receive short-course therapy. Patients undergoing short-course therapy showed higher treatment failure rates (RR 1.61; 95% CI 1.15-2.27; p = 0.006). Furthermore, there were no statistically significant differences between groups regarding reinfection (RR 0.73; 95% CI 0.47-1.13; p = 0156) and relapse rates (RR 1.47; 95% CI 0.8-2.71; p = 0.270). Conclusion: In summary, our results suggest that long-course p.o. antibiotic therapy is associated with a lower rate of treatment failure when compared to short-course p.o. antibiotic therapy. There was no statistical difference between both courses regarding reinfection and relapse rates within 15months. PROSPERO identifier: CRD42023456745. What is Known: • Urinary tract infections (UTIs) are common in children, affecting around 7.5% of those under 18. • The optimal duration of antibiotic treatment for pediatric UTIs has been a subject of debate. What is New: • Short-course therapy (5 or fewer days) was associated with a significantly higher failure rate when compared to long-course therapy. • There was no significant difference in reinfection and relapse rates within 15months between short and long-course therapy.

Local Antimicrobial Resistance Trends in Pediatric Urinary Tract Infection: The Importance of Local Surveillance of a Global Problem.

Introduction Urinary tract infections (UTIs) are one of the most common pediatric bacterial infections and consequently a major reason for antibiotic treatment. Despite being a global problem, antimicrobial resistance is often geographically heterogeneous. Thus, it is fundamental to know local epidemiology and practice frequent surveillance of each hospital's antibiograms. The aims of this study areto determine the local antimicrobial resistance profile in pediatric UTIs, to understand its evolution over 14 years, and finally, to infer if the currently instituted antibiotic empirical therapy remains effective. Materials and methods A retrospective observational study was performed through the analysis of urine cultures and respective antibiograms of children diagnosed with UTIfrom 2017 to 2019 in Centro Hospitalar Universitário do Algarve (Faro's unit, Portugal), followed by a comparison of the obtained datawith the results of a similar study performed between 2003 and 2005. Results A total of 784 urine cultures were selected. Escherichia coli was the most frequent microorganism (n = 561; 71.56%), followed by Proteus mirabilis (n = 117; 14.92%) and Klebsiella pneumoniae (n = 40; 5.10%). The most commonly prescribed antibiotic was cefuroxime axetil (66.28%). Escherichia coli had an increase in resistance to amoxicillin-clavulanate of 6.16% to 34.76% and cefuroxime axetil of 0.73% to 4.46%. Proteus mirabilis had an increase in resistance to amoxicillin-clavulanate of 1.64% to 11.11%. Klebsiella pneumoniae had an increase in resistance to cefuroxime axetil (0%-27.50%) and nitrofurantoin (0%-47.50%). The three microorganisms showed a decrease in trimethoprim-sulfamethoxazole resistance profiles, as well as low resistance profiles to fosfomycin. In fifty cases in which antibiotic empirical therapy was instituted, the isolated microorganism revealed in vitro resistance; 37 of these cases had a good evolution, maintaining the antibiotic empirical therapy. Discussion Local surveillance of antimicrobial resistanceallows monitoring of the resistance trends and adequacy of empirical antibiotic therapy. This study's local resistance profile was distinct from other regions of the country and the world. Continuous local surveillance also potentiates the dissemination of the results to the concerned healthcare providers and the initiation of timely responsive measures, containing the increase in antimicrobial resistance. As Escherichia coli was the commonest isolated microorganism, its antimicrobial profile should dictate antibiotic empirical therapy. This study supports that in vitro is not equivalent to in vivo resistance. Conclusion There was a significant increase in antimicrobial resistance profiles, especially to amoxicillin-clavulanate. Cefuroxime axetil remains the recommended antibiotic for empirical therapy in this hospital, although fosfomycin should be considered as an alternative in non-complicated cystitis in adolescent females. This study reinforces the importance of continuous local resistance surveillance as a preventive measure against the global increase in antimicrobial resistance.

Concentration of novel urinary tract infection biomarkers in neonates

Urinary tract infections (UTIs) are a common comorbidity in hospitalized neonates. The current UTI diagnostics have several limitations including invasive collection of urinary samples to ensure sterility, risk of contamination and lack of consensus definitions of UTI based on urine culture. Antimicrobial peptides (AMPs) have been recently utilized as novel biomarkers that can efficiently and accurately diagnose pediatric UTI. However, the concentration of AMPs in neonatal urine is not well-defined. Urine from neonates admitted to a single level IV neonatal intensive care unit was obtained to determine baseline concentration of two AMPs, Ribonuclease 7 (RNase 7) and Beta Defensin-1 (BD-1) and to define the relationship between AMP concentration and gestational age (GA). AMP levels were normalized to urine creatinine. RNase 7 and BD-1 were expressed in neonatal urine (n = 66) regardless of GA and as early as 22 weeks gestation. Urinary concentrations of both AMPs decreased as GA and birthweight increased. The overall median urinary RNase 7/UCr and BD-1/UCr values were 271 ng/mg, and 116 ng/mg, respectively. Median urinary concentrations of RNase 7/UCr for infants born at < 27, 27–32, 33–35 and ≥ 36 weeks were 569, 308, 254, and 124 ng/mg respectively. Similarly, the concentrations of BD-1/UCr at these GA were 166, 115, 108, and 14 ng/mg, respectively. Baseline neonatal urinary concentration of two AMPs (RNase 7 and BD-1) and the variation by GA were identified. This is an essential first step toward the potential utilization of AMPs in improving neonatal UTI diagnostics.

Bacteriological Profile and Antimicrobial Resistance Patterns in Pediatric Urinary Tract Infections: A Cross-Sectional Study at Dhaka Shishu Hospital

Background: Urinary tract infections (UTIs) are a prevalent concern in pediatric healthcare, causing distress to children, raising parental concerns, and potentially leading to lasting kidney damage. The highest incidence of first-time symptomatic UTIs occurs in infants during the first year of life, with a subsequent marked decrease. Febrile infants under 2 months, presenting with unexplained fever, constitute a critical subset requiring particular attention. Knowledge of the bacteriological profile and antimicrobial resistance patterns in specific regions is crucial for guiding effective treatment strategies. Methods: A cross-sectional study was conducted at 250 Bedded General Hospital, Jamalpur, Bangladesh from Feb 2016 to Aug 2016 to assess the bacteriological profile and antibiotic resistance patterns in pediatric UTIs. A total of 147 culture-positive UTI patients were included. Bacterial isolates were identified, and colony counts for samples with ≥105 CFU/mL bacteria were considered positive. Antimicrobial susceptibility testing was performed using twelve agents, and resistance patterns were analyzed. Results: Among the 147 culture-positive UTI patients, Escherichia coli (E-coli) was the predominant isolate (70%), followed by Klebsiella spp. (13.6%), Pseudomonas (5.44%), Enterobacter spp (3.40%), Staphylococcus Aureus (3.40%), Proteus (2.72%), and Enterococcus (1.36%). Antimicrobial resistance analysis revealed varying patterns, with Cefradine (79.59%), Co-trimoxazole (SXT) (69.39%), Nalidixic acid (NA) (66.67%), and Ceftazidime (CTM) (48.98%) showing higher resistance rates. No drug exhibited 100% resistance against urinary pathogens, indicating a dynamic resistance landscape. Conclusion: This study highlights the importance of understanding local prevalence and resistance patterns in guiding empirical antibiotic selection for pediatric UTIs. The observed decrease in antimicrobial resistance underscores the need for continuous surveillance and tailored antibiotic strategies. Clinicians should base their treatment decisions on the specific epidemiological context rather than relying solely on universal or national guidelines.

Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic.

Urinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes. To examine the population incidence of UTI in children and assess the changes of the COVID-19 pandemic regarding UTI diagnoses and measures of UTI severity. This retrospective observational cohort study used US commercial claims data from privately insured patients aged 0 to 17 years from January 1, 2016, to December 31, 2021. Time periods included prepandemic (January 1, 2016, to February 29, 2020), early pandemic (April 1 to June 30, 2020), and midpandemic (July 1, 2020, to December 31, 2021). The primary outcome was the incidence of UTI, defined as having a UTI diagnosis code with an accompanying antibiotic prescription. Balancing measures included measures of UTI severity, including hospitalizations and intensive care unit admissions. Trends were evaluated using an interrupted time-series analysis. The cohort included 13 221 117 enrollees aged 0 to 17 years, with males representing 6 744 250 (51.0%) of the population. The mean incidence of UTI diagnoses was 1.300 (95% CI, 1.296-1.304) UTIs per 100 patient-years. The UTI incidence was 0.86 per 100 patient-years at age 0 to 1 year, 1.58 per 100 patient-years at 2 to 5 years, 1.24 per 100 patient-years at 6 to 11 years, and 1.37 per 100 patient-years at 12 to 17 years, and was higher in females vs males (2.48 [95% CI, 2.46-2.50] vs 0.180 [95% CI, 0.178-0.182] per 100 patient-years). Compared with prepandemic trends, UTIs decreased in the early pandemic: -33.1% (95% CI, -39.4% to -26.1%) for all children and -52.1% (95% CI, -62.1% to -39.5%) in a subgroup of infants aged 60 days or younger. However, all measures of UTI severity decreased or were not significantly different. The UTI incidence returned to near prepandemic rates (-4.3%; 95% CI, -32.0% to 34.6% for all children) after the first 3 months of the pandemic. In this cohort study, UTI diagnosis decreased during the early pandemic period without an increase in measures of disease severity, suggesting that reduced overdiagnosis and/or reduced misdiagnosis may be an explanatory factor.

Microbial Profile and Antibiotic Sensitivity Pattern in Urinary Tract Infections among Children Attending a Tertiary Care Center, Idukki District, Kerala: A Cross-sectional Study

Introduction: Over the recent decades, the importance of Urinary Tract Infections (UTI) has been increasingly recognised in children. The occurrence of UTI during childhood may lead to acute and/or chronic consequences, such as impaired renal function, renal scarring, and hypertension. Due to the irrational use of antimicrobials, multidrug resistant bacterial strains are frequent. Hence, there is an urgent need for continuous surveillance of the microbiological profile of UTI. Aim: To investigate the microbial profile and antibiotic sensitivity pattern from the urine of paediatric patients suspected to have UTI in Idukki district, Kerala and to explore its association with seasonal variations. Materials and Methods: This clinical cross-sectional study was conducted in Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Idukki, Kerala, India, from January 2019 to December 2021. The study involved 882 paediatric patients in the age group 0-15 years with symptoms and signs suggestive of UTI. Data regarding age, gender, season, laboratory and culture results, and antibiotic sensitivity pattern were considered as variables of interest. Analysis was performed using mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. The statistical analyses were conducted using Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results: The study involved 882 patients, of which 399 were males (45.2%) and 483 were females (54.8%) with a male-tofemale ratio of 0.8:1. The mean age of patients was four years, and a peak incidence was observed in children in the age group of 1-3 years, with 333 (37.8%) children. Microbial growth was observed in the urine of 325 (36.8%) patients. After excluding normal commensal perineal flora and insignificant bacteriuria, 233 samples had significant growth, with males accounting for 106 (45.5%) and females 127 (54.5%). The male-to-female ratio was 0.8 to 1. These samples mostly exhibited growth of aerobic bacteria (232, 99.6%) and Candida albicans (1, 0.4%). E. coli (106, 45.5%) was identified as the most predominant aetiological agent for paediatric UTI. Conclusion: The results of this study suggest that it would be advisable for paediatricians in Idukki district to refrain from using Ampicillin to treat cases suspected to have UTI. Preventive measures should be advised to all patients, with emphasis on urinary hygiene during the monsoon and winter seasons.

Managing Pediatric Urinary Tract Infections: Key Insights from Recent Studies

Managing Pediatric Urinary Tract Infections: Key Insights from Recent Studies

285. The Pediatric Urinary Microbiome: A Comparison of infants under 12 months with and without Urinary Tract Infection in South Korea

Abstract Background The microbiome of the urinary tract plays a significant role in maintaining health through its impact on bladder homeostasis. Urobiota helps maintain the urothelial integrity and prevents urinary tract infection (UTI), regulating neurotransmission and promoting local immune function. However, the number of studies on the pediatric population, especially those in the infant age group in Asia, is limited. Methods We prospectively analyzed the urine microbiome of 15 Infants under 12 months between Jan. 2022 and Dec. 2022, grouped as UTI and control groups. UTI group was defined with fever (body temperature ≥38°C), pyuria (≥5 WBC/ high power field), significant bacteriuria (positive urine culture with pure growth 50,000 colony forming unit (CFU)/mL in catheterized urine culture) and control group was recruited from healthy infants who came to our hospital for vaccination but were uninfected. The urine samples underwent DNA extraction and 16S ribosomal RNA gene sequencing, urinalysis and urine culture. The Shannon diversity, the relative abundances of genus and species level, was analyzed with a Mann-Whitney U test and Kruskal-Wallis test. Results The number of subjects was fifty and the mean age of the pediatric subjects was 6.2 months old. Ten of the subjects were in the control group (the ratio of male to female was 5:5), and five of the subjects in the UTI group (the ratio of male to female was 2:3). Most common genus are streptococcus, bacteroids, prevotella, citrobacter, and bifidobacterium in control group, while UTI group are frequently dominated by the genus Escherichia coli, streptoccus, bacteroids, prevotella, and bifidobacterium. There was no difference in genus lactobacillus between the two groups. In the analysis of the Shannon diversity, those with UTIs had significantly decreased diversity compared to the control group (P =0.037). The top 20 genus in pediatric urine specimens The comparison of Shannon diversity of control group and pediatric Urinary tract infection group in South Korea Conclusion A urinary microbiome was identified in infants under 12 months and we observed the differences in microbiome diversity and composition. The pediatric urinary microbiome has just begun to be explored, and further research and investigation must be conducted into about different ethic and demographic pediatric population characteristics. Disclosures All Authors: No reported disclosures

Antibiotic resistance patterns of pediatric community-acquired urinary tract infections in a tertiary care center in Jeddah, Saudi Arabia.

Urinary tract infections (UTIs) are common in children. UTIs can lead to serious and permanent damage to the urinary tract if treatment is delayed or insufficient, particularly in repeated infections. Knowledge of antibiotic resistance trends aids in the selection of appropriate empiric antibiotics. There is limited data regarding this in Saudi Arabia. This study aimed to investigate uropathogens and their antibiotic resistance patterns in the pediatric community in a tertiary care center. The study population included children aged 0 to 14 years old who had culture-proven UTIs evaluated in the Department of Pediatrics, King Abdulaziz University Hospital in Jeddah, Saudi Arabia from February 2019 to September 2021. Out of 510 UTI episodes, Escherichia coli (54.5%) was the predominant causative pathogen. Of the total episodes, 137 (26.8%) were caused by extended spectrum beta-lactamase (ESBL) producers. In general, the highest resistance was observed against ampicillin (73.2%), cefazolin (54.6%), co-trimoxazole (46%), and cefuroxime (40.6%), whereas amikacin (0.4%), imipenem (0.8%), and meropenem (0.8%) showed the lowest rates of resistance. Antibiotic resistance is a major concern worldwide due to misuse of antibiotics and subsequent rise of multidrug resistant organisms. Our findings highlight the rise in antibiotic resistance, particularly in E. coli strains. Furthermore, ESBL-producing bacteria were responsible for approximately one-third of UTIs. Our study emphasizes the importance of local antibiograms for pediatric community-acquired infections, as it guides clinicians in every center in the choice of appropriate empiric antibiotic treatment.

Evaluation of new generation systemic immune-inflammation markers to predict urine culture growth in urinary tract infection in children.

Systemic inflammation has been implicated in the development and progression of urinary tract infection (UTI). Accordingly, the aim of this study is to determine whether the white blood cell (WBC), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are useful markers to predict of urine culture growth in children with UTI. The second aim of this study is to evaluate the prevalence of UTI pathogens, antibiotic resistance patterns, and empirical treatment options in children diagnosed with UTI based on laboratory and clinical findings. The study population comprised 413 cases (positive urine culture) and 318 cases (negative urine culture) of pediatric patients with UTI. There was no statistically significant difference observed in the median levels of hemoglobin, hematocrit, and platelet between the negative and positive culture groups. The median levels of monocytes, WBC, NLR, SII, and CRP of the patients with a positive urine culture were shown to be statistically significantly higher than the patients with a negative urine culture. The AUC value was 0.747 (0.710-0.784) for CRP with a cutoff value of 3.2, the sensitivity value was 56.4%, and the specificity value was 98.4% in terms of UTI. The AUC value was 0.733 (0.697-0.769) for SII with a cutoff value of 600, the sensitivity value was 58.4%, and the specificity value was 83.0%. The AUC value was 0.732 (0.697-0.769) for NLR with a cutoff value of 2, the sensitivity value was 57.4%, and the specificity value was 81.1%. WBC, CRP, NLR, PLR, and SII could potentially serve as useful independent diagnostic or complementary markers for disease in children diagnosed with UTI who exhibit a positive urine culture. Escherichia coli was found to be the most common causative agent, and the commonly prescribed antibiotic was cephalosporin. However, it was observed that all identified agents of pediatric UTIs in our center exhibited high resistance to cefuroxime, trimethoprim-sulfamethoxazole, cefixime, ampicillin, and ceftriaxone.

Prescribing Pattern and Efficacy of Oral Antibiotics for Pediatric Urinary Tract Infections in Japan: A Descriptive Study Using a Nationwide Claims Database.

Pediatric urinary tract infections are often treated with third-generation cephalosporins; however, the increasing prevalence of Escherichia coli resistant to cephalosporins has reduced their effectiveness. Although resistance is prevalent in Asia, the prescribing patterns and clinical effectiveness of antibiotics have mostly been reported in the United States. This study aimed to describe the prescription patterns and effectiveness of oral antibiotics for treating pediatric urinary tract infections in Japan. This descriptive study used data from a nationwide Japanese claims database. We identified patients aged <6 years with urinary tract infections who received oral antibiotics between January 2016 and December 2020. Descriptive analyses were performed to assess prescription patterns. Moreover, logistic regression analyses were conducted to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for treatment failure among the commonly prescribed antibiotics and patient characteristics. Treatment failure was defined as the prescription of different antibiotics within 7 days of the primary prescription. Of the 4,127 patients, 2,766 (67.0%) were prescribed third-generation cephalosporins, and 347 (8.4%) were prescribed amoxicillin. Trimethoprim-sulfamethoxazole and amoxicillin-clavulanate were prescribed to 63 (1.5%) and 50 (1.2%) patients, respectively. Treatment failure was observed in 118 (2.9%) patients and more often in amoxicillin-treated patients than in cefcapene pivoxil-treated patients [OR, 2.18 (95% CI: 1.04-4.58)]. Third-generation cephalosporins are the most commonly prescribed antibiotics for the initial therapy of pediatric urinary tract infections in Japan. Third-generation cephalosporins are still effective in Japan, despite the high prevalence of resistance against cephalosporins.

Antibiotic Prescribing Practices for Urinary Tract Infection in a Pediatric Emergency Department: Is This a Problem Worth Cefix-ing?

Pediatric urinary tract infection (UTI) is associated with diagnostic and therapeutic challenges. To determine the least-broad-spectrum oral antibiotic that would cover 80% of pathogens from lower (afebrile) and upper (febrile) UTIs in a Canadian pediatric emergency department (ED). This retrospective case series involved children discharged from the ED between September 2020 and February 2021 with a diagnosis of UTI and collection of a sample for urinalysis that had growth on culture. Of 188 patients who met the inclusion criteria, 184 (97.9%) were discharged on antibiotics. Culture results indicated a UTI in 170 cases (92.4% of those discharged on antibiotics). The 95 urinary isolates from lower UTIs were susceptible to cephalexin (n = 81, 85.3%), cefixime (n = 78, 82.1%), nitrofurantoin (n = 76, 80.0%), trimethoprim-sulfamethoxazole (TMP-SMX) (n = 64, 67.4%), and amoxicillin (n = 55, 57.9%). The 75 urinary isolates from upper UTIs were susceptible to cefixime (n = 71, 94.7%), TMP-SMX (n = 57, 76.0%), and amoxicillin (n = 48, 64.0%). The mean prescribed duration of antibiotic therapy was 8.3 days for patients with a lower UTI and 9.1 days for those with an upper UTI (mean difference 0.80 days, 95% confidence interval 0.05-1.54). Empiric treatment with cephalexin or nitrofurantoin would have been successful for almost all lower UTIs. More complete reporting of cephalexin minimal inhibitory concentrations might have allowed use of this drug for most upper UTIs. Although there was a trend toward shorter duration of therapy for lower versus upper UTI, lower UTIs were always treated for longer than recommended by current guidelines.

The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection

The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection

Conflicting views of physicians and surgeons concerning pediatric urinary tract infection: a comparative review

BackgroundA first febrile urinary tract infection (UTI) is a common condition in children, and pathways of management have evolved over time.ObjectiveTo determine the extent to which pediatricians and surgeons differ in their investigation and management of a first febrile UTI, and to evaluate the justifications for any divergence of approach.Materials and methodsA literature search was conducted for papers addressing investigation and/or management following a first febrile UTI in children published between 2011 and 2021. Searches were conducted on Medline, Embase, and the Cochrane Controlled Trials Register. To be eligible for inclusion, a paper was required to provide recommendations on one or more of the following: ultrasound (US) and voiding cystourethrogram (VCUG), the need for continuous antibiotic prophylaxis and surgery when vesicoureteral reflux (VUR) was detected. The authorship required at least one pediatrician or surgeon. Authorship was categorized as medical, surgical, or combined.ResultsPediatricians advocated less imaging and intervention and were more inclined to adopt a “watchful-waiting” approach, confident that any significant abnormality, grades IV–V VUR in particular, should be detected following a second febrile UTI. In contrast, surgeons were more likely to recommend imaging to detect VUR (p<0.00001), and antibiotic prophylaxis (p<0.001) and/or surgical correction (p=0.004) if it was detected, concerned that any delay in diagnosis and treatment could place the child at risk of kidney damage. Papers with combined authorship displayed intermediate results.ConclusionThere are two distinct directions in the literature regarding the investigation of an uncomplicated first febrile UTI in a child. In general, when presented with a first febrile UTI in a child, physicians recommend fewer investigations and less treatment, in contrast to surgeons who advocate extensive investigation and aggressive intervention in the event that imaging detects an abnormality. This has the potential to confuse the carers of affected children.

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

(1) Background: Urinary tract infections (UTIs) are among the most common infections in the pediatric population. This study aimed to analyze the urine culture results and antimicrobial patterns over the last 5 years in children diagnosed with UTI. (2) Methods: Retrospective analysis of medical records of 242 patients hospitalized in the Pediatric Nephrology Department diagnosed with a UTI in the years 2018-2022. (3) Results: The most common causative agent was E. coli, responsible for 64% of UTIs, followed by Klebsiella spp. (16%), Pseudomonas spp. (6%), Enterobacter spp. (4%), Proteus spp. (4%), and Enterococcus spp. (3%). Non-E. coli UTIs were significantly more frequently observed in patients with congenital anomalies of the kidney and urinary tract or neurogenic bladder and patients receiving antibiotic prophylaxis. For the whole study period, 32% of E. coli were resistant to amoxicillin/clavulanic acid, 23.3% to trimethoprim/sulfamethoxazole, 12.2% to ciprofloxacin, and 4.4% to nitrofurantoin. During 2018-2022, the prevalence of E. coli resistant to amoxicillin/clavulanic acid varied from 16.7% to 41.2%, and resistance to cefuroxime increased four times (from 4% in 2018 to 16.7% in 2022). Starting in 2021, all isolated E. coli strains were classified as susceptible-increased exposure or resistant to cefuroxime. (4) Conclusion: Managing pediatric UTIs remains challenging in clinical practice. The choice of optimal empiric treatment should be considered following local recommendations and individual risk factors assessment and require careful dosage adjustment. Observed changes in antimicrobial resistance indicated the need for frequent updating of local recommendations for the management of pediatric patients with UTIs.

Short-Course Therapy for Pediatric Urinary Tract Infections

Short-Course Therapy for Pediatric Urinary Tract Infections