Pediatric Urinary Tract Infection Research Articles

Decreasing the Use of Cefdinir for Pediatric Urinary Tract Infections in a Rural Health Care System: A Quasi-experimental Study.

There are several antimicrobial options for treating urinary tract infection in children. Although cefdinir is commonly used, better options exist. We developed an intervention bundle to reduce the use of cefdinir in favor of cephalexin. The intervention bundle decreased cefdinir use by 19.1% while use of cephalexin increased by 19.8%.

A-260 Mapping pediatric urinary tract infections: trends, prevalence and sensitivity to antimicrobials

Abstract Background Urinary tract infections (UTIs) rank among the most prevalent bacterial infections in pediatric populations, with neonates being particularly susceptible. Moreover, UTIs have a propensity for recurrence, posing ongoing health challenges. Prompt diagnosis of pediatric UTIs is crucial for timely and effective treatment, averting potential long-term complications. While clinical signs often suggest UTI diagnosis, additional tests like urinalysis and urine culture are vital to identify the causative pathogen and its antibiotic sensitivity. This study aims to quantify microorganism prevalence in positive pediatric urine tests and assess their antimicrobial resistance profiles. The purpose is, therefore, to offer scientific basis so that there is greater agility in establishing the diagnosis of UTIs in children and indicating the best antibiotic to be used empirically to prevent late consequences. Methods Between January and December 2019, a cross-sectional study was carried out with urine samples from children and adolescents collected in the database of the Clinical Analysis Laboratory of Cuiabá - MT in 2019. Only records of samples collected in the study were included in the study. laboratory of patients of both sexes, age range 1 month to 15 years. Bacterial analyzes were classified according to Gram positive, Gram negative (glucose fermenters or non-fermenters) and the sensitivity profile was standardized according to the Clinical and Laboratory Standards Institute (2019). The data were subjected to descriptive statistical analysis. Results Of the 532 positive urine samples from pediatric patients, enterobacteria were responsible for 435 (81.76%) with E. coli (64.1%) and Proteus mirabilis (15.8%) being the most isolated bacteria, in relation to Gram-positive bacteria 64 (12.03%) main bacteria was Enterococcus faecalis (81.2%) and non-glucose fermenters for 33 (6.2%) corresponding to Pseudomonas aeruginosa. E. coli, with 279 cases, was the most frequently isolated microorganism, representing (64.1%) of the cases. Females were the most affected, in 83.5% there was growth of Enterobacteria, in the Pseudomonas aeruginosa group, 51.5% of cases were female. and in Gram+ girls represented 56.2%. In those tested only for E. coli, the highest sensitivity was observed in fosfomycin (97.82%). Enterobacteriaceae showed high susceptibility to meropenem (99.8%), ertapenem (99.8%), ceftriaxone (93.8%), and ceftazidime (93.6%), but exhibited considerable resistance to sulfamethoxazole/trimethoprim (35.5%), amoxicillin (33.4%) and ampicillin (29.2%). Pseudomonas aeruginosa and gram positive bacteria were sensitive to all antibiotics tested. Conclusions The data indicate that E. coli continues to be the predominant agent in pediatric UTIs, particularly affecting females and the very young age group < 3 years. Regarding sensitivity profiles, bacteria were more sensitive to carbapenems and aminoglycosides. Early diagnosis is crucial to preventing long-term complications associated with UTIs in children. Consequently, this research provides a scientific basis for faster UTI diagnosis and empirical antibiotic selection in pediatrics, which may prevent late adverse outcomes.

Pediatric Urinary Tract Infection: Evaluation Antibiotic Susceptibility and Biofilm Formation Dynamics

Pediatric Urinary Tract Infection: Evaluation Antibiotic Susceptibility and Biofilm Formation Dynamics

221 Opportunities for Antibiotic Stewardship for Pediatric Urinary Tract Infection for Outpatient Emergency Department and Urgent Care Encounters

221 Opportunities for Antibiotic Stewardship for Pediatric Urinary Tract Infection for Outpatient Emergency Department and Urgent Care Encounters

Molecular detection of Pseudomonas aeruginosa isolated from children with urinary tract infections

The purpose of this research was to identify Pseudomonas aeruginosa from pediatric UTI samples using molecular methods. Bacteria were isolated and identified using a primary medium. Children from all around Baghdad city who were hospitalized at a private clinic between 2019 to 2022 and showed symptoms of a urinary tract infection (UTI) such as fever and vomiting, had their urine sampled. There were 132 samples of children's urine collected from kids who had UTIs. The VITEK-2 system was completed on pure bacterial isolates. DNA of these bacteria was done and two primers were used in this study for the detection of P. aeruginosa. The present study showed that the rate of infection by P. aeruginosa was 7.6%, the total Gram-positive bacteria were 22.7% and the total Gram-negative bacteria were 77.3%. It was shown that females had a greater rate of UTI (55.3% vs. 44.7%) than males. In conclusion, because of its prevalence and severity in community-acquired UTIs in children and its unique risk factors and outcomes, P. aeruginosa should be suspected in any child who has recently received or is now receiving antibiotic treatment.

Insights into Hospitalized Children with Urinary Tract Infections: Epidemiology and Antimicrobial Resistance Patterns in Israel-A Single Center Study.

Background: The escalating resistance of uropathogens in pediatric febrile urinary tract infection (F-UTI) is a global concern. This study examined changing trends in F-UTI epidemiology and resistance patterns among Israeli pediatric inpatients over a decade. Methods: Demographic, clinical, and laboratory data for children between 3 months and 18 years old with febrile UTI from 2010 to 2021 were retrieved from electronic medical records. Results: A total of 761 cases of F-UTI were identified (702 females, mean age 43 months). Escherichia coli was the most common pathogen (85.9%), followed by Pseudomonas aeruginosa (3.5%) and Klebsiella pneumoniae (3.4%). Compared with the non-complicated UTI group, the complicated UTI group had significantly higher rates of Pseudomonas aeruginosa (5.3% vs. 1.0%, p = 0.002) and Klebsiella pneumoniae (4.6% vs. 1.6%, p = 0.03). Antibiotic resistance analysis revealed significant differences between the groups: resistance to cephalexin was higher in the complicated UTI group (19.3%) compared with the non-complicated UTI group (13.4%, p = 0.03). Notably, relatively low resistance rates were observed for ceftriaxone (4.4%) and gentamicin (6.0%). Over time, a significant decreasing trend in resistance to ampicillin was observed (slope = -0.0193, p = 0.011). No significant trends were found for trimethoprim-sulfamethoxazole, cephalexin, amoxicillin-clavulanic acid, ceftriaxone, and cefuroxime. Conclusions: Significant differences in pathogen distribution and resistance patterns between complicated UTI and non-complicated UTI groups highlight the need for continuous resistance monitoring and adherence to local guidelines. For the treatment of severe community F-UTI, ceftriaxone could be a reasonable option for first-onset F-UTI. Further studies are needed to implement antibiotic stewardship and optimize usage.

Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study.

While the definitive diagnosis of urinary tract infection (UTI) requires a positive urine culture, the likelihood of UTI can be determined by urinalysis that includes white blood cell (WBC) count. We aimed to determine the optimal urine WBC threshold in urinalysis to predict UTIs in children presenting at the emergency department (ED). We performed a prospective observational study in the ED at KK Women's and Children's Hospital for children below 18 years old who underwent both urine microscopy and urine cultures, between 10 January and 7 November 2022. We assessed the various urine WBC thresholds associated with culture-proven UTIs using sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and area under receiver operating characteristic curve. We found a culture-proven UTI rate of 460/1188 (38.7%) among all patients analysed, and 278/998 (27.9%) among those with nitrite-negative urine samples. Among all patients, a urinalysis WBC threshold of 100/μL had a sensitivity of 82.2% (95% confidence interval [CI] 78.4-85.5) and negative predictive value of 86.2% (95% CI 83.6-88.4). Among those who were nitrite-negative, a WBC threshold of ≥100/μL resulted in a potential missed rate of 48/278 (17.3%). By lowering the WBC threshold to ≥10/μL, the potential missed cases reduced to 6/278 (2.2%), with an estimated increase in 419 urine cultures annually. A urine microscopy WBC threshold of ≥100/μL results in a clinically significant number of missed UTIs. Implementation of various thresholds should consider both the potential missed UTI rate and the required resource utilisation.

Distribution and antimicrobial susceptibility of pathogenic micro-organisms in pediatric urinary tract infections

Distribution and antimicrobial susceptibility of pathogenic micro-organisms in pediatric urinary tract infections

Whole-Genome Sequencing Reveals Temporal Trends in Antibiotic Resistance Genes in Escherichia coli Causing Pediatric Urinary Tract Infections in Central Vietnam.

(1) Background: Pediatric urinary tract infections (UTIs) pose significant challenges due to drug-resistant Escherichia coli (E. coli) strains. This study utilizes whole-genome sequencing to analyze temporal trends in antibiotic resistance genes (ARGs) in clinical E. coli isolates from pediatric UTI cases in central Vietnam. (2) Methods: We conducted whole-genome sequencing on 71 E. coli isolates collected from pediatric UTI patients between 2018 and 2020. ARGs were identified, and their prevalence over time was analyzed. Statistical tests were used to correlate ARG presence with antibiotic resistance. (3) Results: Of the 47 E. coli isolates with complete data, 40 distinct ARGs were identified, with a median of 10 resistance genes per isolate. A significant increase in the total number of ARGs per isolate was observed over time, from an average of 8.88 before June 2019 to 11.63 after. Notably, the prevalence of the aadA2 gene (aminoglycoside resistance) rose from 0% to 26.7%, and that of the blaNDM-5 gene (beta-lactam and carbapenem resistance) increased from 0% to 23.3%. Key correlations include blaEC with cephalosporin resistance, blaNDM-5 with carbapenem resistance, and sul2 with sulfamethoxazole/trimethoprim resistance. (4) Conclusions: Whole-genome sequencing reveals complex and evolving antibiotic resistance patterns in pediatric E. coli UTIs in central Vietnam, with a marked increase in ARG prevalence over time. Continuous surveillance and targeted treatments are essential to address these trends. Understanding genetic foundations is crucial for effective intervention strategies.

Capitalizing on Implementation Science to Advance Antimicrobial Stewardship and Health Equity in Treating Pediatric UTI’s

Background: Pediatric urinary tract infections represent the most common pediatric infection with increasing gram-negative antibiotic resistance. Overutilization of antimicrobials including third generation cephalosporins are known drivers of this resistance. Antimicrobial stewardship (AS) efforts have recently shown that antibiotic selection may be influenced by patient race. Implementation science (IS) can provide frameworks and strategies to improve antimicrobial utilization and equity. Methods: This was a pre/post study of 2 geographically different children’s hospitals general pediatric floors assessing the impact of a set of implementation strategies developed to improve provider knowledge of best practice antimicrobials (based on local susceptibilities for treatment of UTI’s) and influence uptake of best practice prescribing. IS strategies included provider education, local clinical champion and opinion leader involvement, leadership involvement, local policy changes, and stakeholder co-design of decision support tools (a clinical pathway, a specific ITI antibiogram, and a dynamic order set). No education was provided regarding racial differences in prescribing habits. Outcomes were measured utilizing a portion of the RE-AIM Framework of assessing adoption of “Right” antibiotic, order set adoption, and equitable reach (racial differences in prescribing). Results: Hospital A and B had a first-generation cephalosporin prescription rate of 29.7% (n=441) and 20.6% (n-557) pre implementation and 44.6% (n=84) and 47.5% (n=118) post (p < 0 .001). Both hospitals also saw a significant reduction in third-generation cephalosporins. In Hospital A, APRN’s were more likely to prescribe a first generation cephalosporin (52.4%) than a DO (42.1%) or MD (26.4%) pre-implementation (p=0.004). In Hospital B, APRN’s were less likely to prescribe first generation cephalosporins (5.4%) than a DO (28.9%) or MD (19.4%) pre-implementation (p=0.004). No statistical significance was seen post implementation for antimicrobial selection by provider type for either hospital. Based on race, both hospitals had Black and Other patients receiving more first-generation cephalosporins while white patients were more likely to receive third-generation cephalosporins (p=0.033) pre implementation. No statistical significance was seen post implementation for antimicrobial selection based on race. No improvement was seen in order set utilization. Conclusion: With order set utilization not improving with implementation of new dynamic order set, other strategies such as education, clinical champion and opinion leader involvement, and provision of a local UTI antibiogram were likely contributors to the improvement in best antimicrobial for treatment of UTI’s. Further mixed method research is warranted to improve understanding of the relative performance of our strategies, especially the lack of provider adoption of the novel dynamic order set.Disclosure: Jessica Snowden: Advisory board - Pfizer

Evaluation of the Quantity and Quality of Antibiotic Use in Inpatient Pediatric Urinary Tract Infection (UTI) Patients at RSUD KRMT Wongsonegoro Semarang

Evaluation of the Quantity and Quality of Antibiotic Use in Inpatient Pediatric Urinary Tract Infection (UTI) Patients at RSUD KRMT Wongsonegoro Semarang

Pediatric urinary tract infections caused by poultry-associated Escherichia coli.

Escherichia coli is the leading cause of urinary tract infections (UTIs) in children and adults. The gastrointestinal tract is the primary reservoir of uropathogenic E. coli, which can be acquired from a variety of environmental exposures, including retail meat. In the current study, we used a novel statistical-genomic approach to estimate the proportion of pediatric UTIs caused by foodborne zoonotic E. coli strains. E. coli urine isolates were collected from DC residents aged 2 months to 17 years from the Children's National Medical Center Laboratory, 2013-2014. During the same period, E. coli isolates were collected from retail poultry products purchased from 15 sites throughout DC. A total of 52 urine and 56 poultry isolates underwent whole-genome sequencing, core genome phylogenetic analysis, and host-origin prediction by a Bayesian latent class model that incorporated data on the presence of mobile genetic elements (MGEs) among E. coli isolates from multiple vertebrate hosts. A total of 56 multilocus sequence types were identified among the isolates. Five sequence types-ST10, ST38, ST69, ST117, and ST131-were observed among both urine and poultry isolates. Using the Bayesian latent class model, we estimated that 19% (10/52) of the clinical E. coli isolates in our population were foodborne zoonotic strains. These data suggest that a substantial portion of pediatric UTIs in the Washington DC region may be caused by E. coli strains originating in food animals and likely transmitted via contaminated poultry meat.IMPORTANCEEscherichia coli UTIs are a heavy public health burden and can have long-term negative health consequences for pediatric patients. E. coli has an extremely broad host range, including humans, chickens, turkeys, pigs, and cattle. E. coli derived from food animals is a frequent contaminant of retail meat products, but little is known about the risk these strains pose to pediatric populations. Quantifying the proportion of pediatric UTIs caused by food-animal-derived E. coli, characterizing the highest-risk strains, and identifying their primary reservoir species could inform novel intervention strategies to reduce UTI burden in this vulnerable population. Our results suggest that retail poultry meat may be an important vehicle for pediatric exposure to zoonotic E. coli strains capable of causing UTIs. Vaccinating poultry against the highest-risk strains could potentially reduce poultry colonization, poultry meat contamination, and downstream pediatric infections.

Emergency Department Antibiotic Prescribing for Pediatric Urinary Tract Infections, 2011–2020

Emergency Department Antibiotic Prescribing for Pediatric Urinary Tract Infections, 2011–2020

Molecular Identification of Kocuria Species Isolated from Pediatric Teaching Hospital in Sulaymaniyah, Iraq

Abstract Background: Kocuria species is now increasingly being recognized as an emerging human pathogen, suggesting that this genus has mostly been neglected or misidentified. Objective: This study attempts to use molecular techniques to correctly identify Kocuria species isolated from inpatient children, and to compare between the identification results obtained from two methods: VITEK 2 and 16S rRNA gene sequencing. Materials and Methods: VITEK 2, an automated system, was used to identify clinical isolates. Isolates identified as Kocuria spp. were submitted to DNA extraction and polymerase chain reaction testing. A partial sequence of the 16S rRNA gene was constructed and compared to GenBank sequences of the 16S rRNA gene. To confirm the strains’ identity, a phylogenetic tree including all Kocuria species was constructed. Results: Three isolates of Kocuria spp. were identified; the first two isolates were confirmed as K. kristinae by VITEK 2, pairwise 16S rRNA sequencing, and phylogenetic tree. However, the third isolate was identified as K. rosea, contradicting the pairwise 16S rRNA sequencing and phylogenetic tree identification as K. turfanensis. Conclusion: It is crucial to utilize molecular techniques for correctly identifying Kocuria species. In this study, it is found that K. turfanensis emerges as a pathogenic species and the first known cause of meningitis in humans and K. kristinae is identified as the first known cause of pediatric urinary tract infections.

Pediatric Urinary Tract Infections at a Tertiary Care Center: Microbial Diversity and Antibiotic Resistance Patterns

Abstract Introduction: Urinary tract infection (UTI) remains a prevalent bacterial infection among the pediatric age group, ranking as the third-most common bacterial infection in children in developing countries, following gastrointestinal and respiratory tract infections. It continues to pose a significant health challenge. Materials and Methods: The urine samples underwent gross examination, wet mount, and Gram stain. Semiquantitative cultures were conducted on conventional media (MacConkey agar, blood agar, and CLED agar) and UTI chromogenic media. Uropathogen identification employed standard microbiological techniques. Antibiotic susceptibility was determined using the Kirby–Bauer disk diffusion method, with interpretation based on CLSI guidelines. Plates were incubated overnight, and clear zone diameters around antibiotic discs were measured for sensitivity or resistance determination. Results: The study comprised 64.75% male children and 35.25% female children. Analyzing the age distribution, the majority of participants fell within the age range of 1–5 years (35%), followed by those <1 year (33.75%), and the age group of 5–12 years, accounting for 31.25% of the total 400 participants. The findings from our investigation revealed a UTI prevalence of 17.25%, with Escherichia coli and Klebsiella emerging as the predominant uropathogens. Notably, these pathogens exhibited a significant susceptibility to carbapenems, nitrofurantoin, and amikacin. Conclusion: Our study identified a male predominance and various age distributions among UTI patients. Antibiotic susceptibility patterns revealed E. coli and Klebsiella pneumoniae’s high sensitivity to key antibiotics, whereas Enterococcus spp. exhibited significant high-level aminoglycoside resistance. This study underscores the importance of tailored antibiotic strategies based on local resistance profiles to combat UTIs effectively.

Comparative analysis of antibiotic prescription and resistance patterns in the management of pediatric urinary tract infections

Abstract: INTRODUCTION: Urinary tract infections (UTIs) exhibit a significant prevalence rate in the pediatric population. Antibiotic therapy is a commonly recommended treatment option. Our objective was to investigate the resistance pattern of antibiotics in relation to the prescribed drugs among pediatric patients. MATERIALS AND METHODS: This was a retrospective analysis of pediatric patients with diagnosed UTIs. A total of 100 samples were analyzed for culture and sensitivity. RESULTS: Escherichia coli (33%) was the most common organism isolated, followed by Klebsiella (27%) and Enterococcus (12%). Ceftriaxone (CTR) (85%) was the most commonly prescribed drug, followed by cefixime (CFM) (32%) and ciprofloxacin (25%). The overall resistance pattern of antibiotics to pathogens isolated was highest for cefoperazone (51%), nitrofurantoin (36%), amikacin (28%), and gentamicin (24%). The lowest resistance was observed for vancomycin (0%). The overall sensitivity was highest for imipenem (65%) and piperacillin-tazobactam (50%). The lowest sensitivity was observed for cefotaxime and ceftazidime. CONCLUSION: CTR and CFM were the commonly prescribed drugs for pediatric UTI treatment due to their low resistance rate and adequate sensitivity, high efficacy, well-tolerance, and convenient administration.

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.

Antimicrobial resistance pattern and uropathogens distribution in children visiting a referral hospital in Mogadishu.

Aim: Studies concerning epidemiology and drug susceptibility patterns of pediatric urinary tract infection in developing countries are scarce. This study aimed to evaluate the antimicrobial resistance pattern and uropathogens distribution in children. Method: Four-year retrospective study included 840 participants in all pediatric age groups whose urine had been cultured. Results: The prevalence of culture-proven pediatric UTIs was 17.6% (148/840). Escherichia coli was the most common pathogen isolated from the cultures, accounting for (48%, 71/148), followed by Klebsiella pneumoniae (16.2%, 24/148). About 27% of the pathogens had a multidrug-resistant (MDR) pattern. A resistance rate against nitrofurantoin at 24.6%, fosfomycin at 15.2% and trimethoprim-sulfamethoxazole (SMX-TMP) at 79.7% was noted. Conclusion: E. coli and Klebsiella pneumoniae were the most common pathogens isolated.

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