Urinary Tract Infection In Children Research Articles

Urinary tract infections in children with cancer and febrile neutropenia - single center experience

Background/Aim. Urinary tract infection (UTI) in children with febrile neutropenia (FN) after receiving chemotherapy could be followed by atypical symptoms and signs. The absence of routine urine culture (UC) sampling for analysis could lead to undiagnosed disease and inadequate treatment of these patients. The aim of the study was to indicate the importance of sampling UC in children who have developed FN and to point out the most probable causative agents of UTI in children with FN and antibiotic sensitivity/resistance of the isolated strains. Methods. During a five-year observation period, 40 UTIs were registered in 30 patients with FN. In the study group of patients with FN, the number of UTIs, the number of recurrent UTIs, isolated pathogens, their sensitivity to antibiotics, characteristics of urine sediment, the presence of localized symptoms of UTI, and the presence of urosepsis were analyzed. The obtained results were compared with the control group which consisted of children who were healthy prior to hospitalization due to febrile urinary infection. Results. When compared to the control group, significant differences in the presence of symptoms of UTI and urine sediment findings in patients with FN were observed. A higher percentage of resistant strains of Escherichia coli isolated from UC of cancer patients with FN was noted when compared to the control group. Three UTI cases were followed by urosepsis. Conclusion. UC findings are important not only in establishing the diagnosis of UTI and detecting multi-resistant bacterial strains but also in choosing appropriate antibiotics and selecting a subgroup of patients with recurrent UTI who require further monitoring and detecting potential complications in a timely manner.

RESULTS OF BACTERIOLOGICAL MONITORING OF URINARY TRACT INFECTIONS IN CHILDREN OF ZAPORIZHZHIA REGION IN 2023

The aim of the study. To investigate the structure of pathogens of acute urinary tract infections in children of Zaporizhzhia region in 2023 and their sensitivity to antibacterial agents. Materials and methods. The analysis of the structure of pathogens in acute urinary tract infections and the determination of their sensitivity to antibiotics based on the results of bacteriological urine cultures of 322 children with acute urinary tract infections treated at the Zaporizhzhia Regional Children's Hospital in 2023 was performed. For each isolate, the multidrug resistance index was calculated, which allowed to judge the relative integral resistance of the isolated microorganisms to antibacterial drugs. Results. It was established that the most common cause of urinary tract infections in children were gram-negative microorganisms (61.0%), including Escherichia coli (37.4%) and Klebsiella pneumoniae (10.8%) which were most often verified. Gram-positive bacteria were identified in 38.5% of patients, among which the Enterococcus bacteria (29.2%) predominated. High resistance of Escherichia coli to amoxicillin/clavulanate (31.5%), ciprofloxacin (30.1%), cefepime (20.1%), and ceftazidine (20.5%) was detected, including 29 (39.7%) multidrug-resistant isolates of Escherichia coli. The highest resistance of Klebsiella pneumoniae was found to amoxicillin/clavulanate (76.2%), cefepime (33.3%), ceftazidine (33.3%), ciprofloxacin (42.8%), and phosphamycin (28.6%). Multidrug resistance was shown by 76.2% of Klebsiella pneumoniae isolates. The highest susceptibility of Enterococcus bacteria was found to ampicillin (98.2%), linezolid (98.2%), vancomycin (100%), nitrofurantoin (100%), and tigecycline (100%). In no case microorganisms showed complete sensitivity to imipenem, and 17.9% of Enterococcus isolates were resistant to this antibiotic. Conclusions: At the present stage, the dominance of gram-negative microflora among the pathogens of urinary system infections in children remains, among which Escherichia coli (37.4%) continues to be the leading pathogen. The growing role of Enterococcus faecalis (29.2%) as an etiologic factor of urinary tract infections in children was noted, which should be taken into account during the empirical use of antibiotics, especially if there is no effect within the first two days after the start of therapy.

Comparison of Short-Term Therapeutic Effects between Amoxicillin-Clavulanic Acid and Ceftriaxone Sodium on Febrile Urinary Tract Infections in Children under Five Years Old.

Febrile urinary tract infections in children are typically treated with a standard 10-day course of antibiotics. However, prolonged antibiotic use can lead to increased bacterial resistance, underscoring the need to explore shorter treatment regimens. This study aimed to compare the short-term therapeutic effects of amoxicillin-clavulanic acid and ceftriaxone sodium in children under five years old with febrile urinary tract infections. Clinical data from 109 children under five years old diagnosed with febrile urinary tract infections between August 2022 and December 2023 were retrospectively analyzed. Among them, 52 children received ceftriaxone sodium (group A), and 48 children received amoxicillin-clavulanic acid (group B). Clinical symptoms, laboratory indicators, clinical efficacy, and adverse reactions were compared between the two groups. Children from group B showed significantly shorter improvement times for fever, dysuria, and urinary frequency compared to those in group A (p < 0.05). Initially, there were no significant differences in the levels of white blood cell counts, squamous epithelial cells, bacteria, interleukin-6, interleukin-8, and neutrophil gelatinase-associated lipocalin between the two groups (p > 0.05). However, after treatment, group B exhibited significantly lower levels of white blood cell counts, squamous epithelial cells, bacteria, interleukin-6, interleukin-8, and neutrophil gelatinase-associated lipocalin compared to group A (p < 0.05). Moreover, the total effective rate was significantly higher in group B (95.83%) than in group A (80.77%) (p < 0.05). There was no significant difference in the incidence of adverse reactions between groups B (10.42%) and A (13.45%) (p > 0.05). Amoxicillin-clavulanic acid demonstrated superior short-term therapeutic efficacy for febrile urinary tract infections in children under five years old compared to ceftriaxone sodium. It effectively reduced cure times, mitigated inflammatory responses, and improved treatment outcomes, suggesting its potential for broader clinical application and adoption.

Urinary Tract Infection in Children: A Narrative Review.

This study investigates the susceptibility of different age groups and genders to urinary tract infections (UTIs) in pediatric populations, focusing on anatomical and behavioural factors. A systematic review of clinical data explores manifestations, accurate diagnosis methods, and antibiotic treatment regimens. Escherichia coli is a prevalent uropathogen, and the study addresses concerns about antibiotic resistance. The research aims to close knowledge gaps, influence guidelines, and enhance public health initiatives. Factors influencing UTI prevalence, such as age, gender, and structural abnormalities, are discussed. The review follows a robust search methodology, presenting a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The included studies cover a wide range of topics related to pediatric UTIs, including aetiology, treatment, prevention, and diagnostic approaches. The study emphasizes the importance of understanding and addressing pediatric UTIs for effective management and prevention.

A cross-sectional study of clinical a nd microbiological profile of urinary tract infections in children from tertiary care centre in Maharashtra

Abstract Introduction: Urinary tract infections (UTIs) are common in children, often leading to renal damage if not promptly treated. Understanding the changing epidemiology, causative agents, and antibiotic resistance patterns is crucial for effective management. Methods: A cross-sectional study was conducted at a tertiary care hospital. 100 children aged 1 month to 18 years diagnosed with UTI based on symptoms, pyuria, and bacteriuria were enrolled. Data on demographics, clinical features, and antibiotic use were collected. Urine samples were cultured, and antimicrobial susceptibility testing was performed. Results: Infants (&lt;1 year) showed a higher male prevalence (69.6%) compared to females (30.4%). Fever was the most common symptom (92%). Escherichia coli (E. coli) was the predominant pathogen (69%), followed by Klebsiella pneumoniae (10%) and Enterobacter spp. (6%). Antibiotic resistance was observed, with 20% sensitive to 4 or fewer antibiotics and 27% sensitive to 9-12 antibiotics. Prior urinary instrumentation, past UTI history, and recent antibiotic use were identified as risk factors for resistance. ESBL-producing organisms showed significant resistance to cephalosporins and ciprofloxacin compared to non-ESBL organisms. Conclusions: UTIs in children show age-specific gender variations and evolving bacterial profiles. E. coli remains the dominant pathogen, but resistance is rising. Prior interventions, past UTIs, and recent antibiotic use are associated with resistance. ESBL-producing organisms pose a particular challenge. These findings highlight the need for judicious antibiotic use and tailored management strategies based on age, bacterial profile, and resistance patterns.

Urinary tract infections in children in the era of growing antimicrobial resistance – recommendations of the Polish Society of Paediatric Nephrology

Introduction and objective: Urinary tract infections can recur in children, and due to their potential long-term consequences, they require appropriate diagnosis and prompt treatment. Although Escherichia coli is the most common aetiology, an increase in infections with drug-resistant strains has been observed. The aim of this study was to develop current diagnostic and treatment recommendations in the era of increasing microbial resistance. Materials and methods: The recommendations are based on updated guidelines developed by the experts of the Polish Society of Paediatric Nephrology and a literature review. Results: Because the symptoms of urinary tract infection are often non-specific, urinalysis and urine culture should be performed in children presenting with fever without an identifiable cause. Correct method of urine collection and interpretation of the results are crucial for therapeutic decisions. Treatment should be continued for 7–14 days for upper and 3–5 days for lower urinary tract infections; the choice of the narrowest-spectrum antimicrobial should be based on bacterial susceptibility. Antibiotic prophylaxis is limited and recommended in children with grade III–V vesicoureteral reflux. Non-pharmacological management should include treatment of bladder and bowel dysfunction. Ultrasound is recommended for all children up to 24 months of age. Indications for voiding cystourethrography are limited to cases with ultrasound abnormalities, recurrent and septic infections. Conclusion: The paper provides up-to-date, practical recommendations for the diagnosis and management of urinary tract infections in children in the era of increasing microbial resistance and restricted indications for invasive radiological investigations.

The Effect of Clean Intermittent Catheterization-Based Nursing Interventions on the Knowledge, Skill, Coping, Adaptation, Anxiety in Caregivers and Infection in Children: A Randomized Controlled Study Protocol

Objective: To explore the effect of clean intermittent catheterization training based on android application-supported Roy Adaptation Model (RAMTAKE) given by nurses to caregivers on their knowledge, skills, coping, adaptation and anxiety levels and the development of infection in the child. &#x0D; Material and Method: The study is a single-center, single-blind, prospective, randomized controlled trial. This randomized controlled trial was reported according to SPRIT. The sample of the study consisted of 42 patients and their caregivers who underwent clean intermittent catheterization in a university hospital. Participants were divided into two separate groups, experimental and control, by simple random sampling method. Participants in the experimental group will be given RAMTAKE, and after being discharged from the hospital, home visits and telephone counseling will be applied by the researchers. The caregivers in the control group will not be subjected to any intervention by the researchers and will be provided with routine clean intermittent catheterization training in the hospital. Study data will be collected using The knowledge, skill level of the caregiver, The Roy Adaptation Model (RAM) psychosocial adaptation areas scale, Coping and Adaptation Scale, The State/Trait Anxiety Scale and UTI development in children. Knowledge, skills, coping, adaptation and anxiety levels of caregivers in both groups will be measured three times. In addition, after discharge from the hospital, children in both groups will be tested for urine culture three times with an interval of one month. Researchers will not interfere with caregivers during the data collection and urine culture analysis phase of the study.&#x0D; Results: How beneficial clean intermittent catheterization is for children who cannot urinate on their own is quite clear. However, the effect of RAMTAKE knowledge/skills, anxiety level and coping/adaptation of the caregivers and the development of infection in children is yet unknown. Within the scope of the study, it is aimed that the knowledge/skills, coping and adaptation levels of the caregivers who receive RAMTAKE will increase and their anxiety level will decrease. In addition, it is thought that the frequency of urinary tract infection will decrease in the children of caregivers who receive RAMTAKE.&#x0D; Conclusion: This study is expected to provide reliable evidence to increase the knowledge, skill, coping, adherence level of caregivers who apply clean intermittent catheterization to their children, and to reduce the anxiety level of caregivers with urinary tract infections in children.

Investigating the clinical outcomes of bulking agent injection in comparison with modified Gil-Vernet anti-vesicoureteral reflux surgery in children with high-grade reflux (4 or 5)

BackgroundVesicoureteral reflux (VUR) is a common condition associated with childhood urinary tract infection (UTI) that can lead to chronic renal failure and hypertension. Various anti-reflux treatments were advocated, with various degrees of morbidity and success. The purpose of this study is to analyze and compare the results of modified Gil-Vernet anti-reflux surgery and bulking agent injection in children with unilateral high-grade reflux.MethodsThe study involved 179 patients who underwent surgical interventions for primary VUR from February 2013 to September 2019. Data on baseline demographics, preoperative symptoms, radiological imaging studies, and postoperative outcomes were analyzed. Treatment goal was defined as when no VUR or downgrading was detected 6 months or later after the intervention.ResultsA total of 128 patients underwent modified Gil-Vernet anti-reflux surgery and 51 patients underwent dextranomer/hyaluronic acid (Dx/HA) injection with mean VUR grading of 4.3 in both groups (P = 0.687). The overall VUR resolution rates were significantly higher in modified anti-reflux surgery rather than Dx/HA injection (86% vs. 68%, P = 0.021). Dx/HA injection was associated with shorter operation time (21 ± 8 min vs. 57 ± 11 min, P = 0.01), and shorter hospital stay (0.34 ± 0.22 days vs. 3.50 ± 0.50 days, P < 0.001). No major complications were identified in both groups.ConclusionsDx/HA injection has a significantly shorter operation time, lower postoperative analgesic usage, and shorter hospital stay, modified Gil-Vernet anti-reflux surgery is associated with significantly higher VUR downgrading and resolution rates than Dx/HA injection, particularly in the higher grade VUR.

Vitamin D supplementation in children with urinary tract infection

Urinary tract infections (UTIs) are one of the most common bacterial infections in the global population. Vitamin D deficiency is also an urgent and common problem, and the high incidence of hypovitaminosis does not depend on age, sex, nationality, and geographical location. Along with the so-called "classical" effects of cholecalciferol, no less significant non-calcemic functions of cholecalciferol have been actively studied over the past two decades, particularly its effect on inflammation and its role in anti-infectious immunity. More and more data on the relationship between UTIs and vitamin D deficiency supports the possible use of cholecalciferol as an adjuvant to basic UTI therapy.&#x0D; Aim. To analyze the vitamin D status in children with UTI compared to healthy ones.&#x0D; Materials and methods. The study included 75 children from 1 month to 18 years with UTIs of various localization treated in a healthcare institution in Stavropol. The mean age of the study patients was 6.0±0.3 years. Vitamin D status was based on serum calcidiol [25(OH)D3] level.&#x0D; Results. The vitamin D level is statistically significantly higher in children of the control group than in patients with UTI: 36.42 ng/mL [24.92–46.37] vs 24.13 ng/mL [13.75–36.42], respectively (p=0.003). There were no patients with severe vitamin deficiency in the control group, while in the UTI group, it occurred in 20.0% of patients. The vitamin D level was less than 20 ng/mL in 31 (41.3%) children with UTI and only 2 (6.6%) in the control group (p=0.001). Normal vitamin status was found in only 38.7% of patients with UTI compared to 66.7% of healthy children (p0.01). The lowest level was found in patients with acute cystitis – 19.7 ng/mL [9.8–19.7], and the highest in patients with acute pyelonephritis – 31.9 ng/mL [14.3–36.4].&#x0D; Conclusion. Based on the study results, it can be concluded that vitamin D deficiency may be one of the risk factors for developing UTIs in children. Further studies involving more patients are needed.

Neonatal Cystitis Makes Adult Female Rat Urinary Bladders More Sensitive to Low Concentration Microbial Antigens.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain disorder. Patients with IC/BPS often experience "flares" of symptom exacerbation throughout their lifetime, initiated by triggers, such as urinary tract infections. This study sought to determine whether neonatal bladder inflammation (NBI) alters the sensitivity of adult rat bladders to microbial antigens. Female NBI rats received intravesical zymosan treatments on postnatal days P14-P16 while anesthetized; Neonatal Control Treatment (NCT) rats were anesthetized. In adults, bladder and spinal cord Toll-like receptor type 2 and 4 (TLR2, TLR4) contents were determined using ELISAs. Other rats were injected intravesically with lipopolysaccharide (LPS; mimics an E. coli infection; 25, 50, 100, or 200 μg/mL) or Zymosan (mimics yeast infection; 0.01, 0.1, 1, and 10 mg/mL) solutions on the following day. Visceromotor responses (VMRs; abdominal contractions) to graded urinary bladder distention (UBD, 10-60 mm Hg, 20s) were quantified as abdominal electromyograms (EMGs). Bladder TLR2 and TLR4 protein levels increased in NBI rats. These rats displayed statistically significant, dose-dependent, robustly augmented VMRs following all but the lowest doses of LPS and Zymosan tested, when compared with their adult treatment control groups. The NCT groups showed minimal responses to LPS in adults and minimally increased EMG measurements following the highest dose of Zymosan. The microbial antigens LPS and Zymosan augmented nociceptive VMRs to UBD in rats that experienced NBI but had little effect on NCT rats at the doses tested. The greater content of bladder TLR2 and TLR4 proteins in the NBI group was consistent with increased responsiveness to their agonists, Zymosan and LPS, respectively. Given that patients with IC/BPS have a higher incidence of childhood urinary tract infections, this increased responsiveness to microbial antigens may explain the flares in symptoms following "subclinical" tract infections.

Vitamin Supplementation and Urinary Tract Infection in Children: A Narrative Review

: Urinary tract infections (UTIs) are one of the most prevalent infections among pediatric patients. Recently, there has been growing interest in the use of vitamins as supplementary therapies. However, the existing research in this field appears to be fragmented and lacking coherence. Thus, this study aimed to provide a comprehensive overview of the current status of vitamin supplements' role in UTI treatment. We reviewed articles in PubMed and Google Scholar from 1950 to 2022. In conclusion, vitamins C, E, and A have shown promising results as adjuvant therapies in UTI.

Long Term Follow-Up Of Patients With Nonrefluxing Hydronephrosis.

The aim of this study is to examine the long-term prognosis of children with ureteropelvic junction obstruction-like hydronephrosis (UPJO-like HN). The files of children with hydronephrosis (HN) were analyzed retrospectively. Patients with vesicoureteral reflux (VUR) and other genitourinary anomalies were excluded. The final status of the HN, the need for surgery, and urinary tract infection (UTI) frequency were evaluated. The study included 219 patients with 302 renal units (RU) with HN. Surgery rate was higher in RUs with larger kidney size and parenchymal thinning (p:<0.001 for both). Hydronephrosis resolved in 113 (40.2%) RUs, improved in 66 (23.3%), unchanged in 100 (35.5%) and worsened in 4 (1.4%). The frequency of recovery and improvement was found to be less in RUs with severe HN, large kidney size, and thin parenchyma. The UTI frequency was higher in severe HN group (12.2% vs 30.6% p:<0.001). Children with mild HN had an excellent prognosis. Although the majority of the patients with high-grade HN had also a good prognosis, it seems important to closely follow up patients with severe HN, increased kidney size, and accompanying parenchymal thinning. Clinicians should be aware of the increased frequency of UTIs in children with severe HN.

A Study on the Relationship Between Breastfeeding Type and Urinary Tract Infections in Children Under the Age of Two Years

This study aimed to investigate the relationship between breastfeeding practices and urinary tract infections (UTIs) in children under the age of two years. Data were obtained from Al-Rifai, Souq AlShuyukh, and Bint Al-Huda maternity hospitals, as well as private laboratories affiliated with outpatient clinics

A cross-sectional descriptive study of culture and urine dipstick methods for evaluation of urinary tract infection in children as a rapid screening tool

A cross-sectional descriptive study of culture and urine dipstick methods for evaluation of urinary tract infection in children as a rapid screening tool

Patterns of antibiotics sensitivity in culture positive cases of urinary tract infections in children.

Objective: To determine the effective narrow spectrum antibiotics for treatment of UTI in children in order to control the rapidly increasing antibiotic resistance to broad spectrum antibiotics. Study Design: Prospective Clinical study. Setting: Department of Pediatric, Akbar Niazi Teaching Hospital, Bhara Kahu-Pakistan. Period: January 2021 to December 2021. Material &amp; Methods: 361 children with clinical suspicion of UTI Urine samples were collected. Antimicrobial sensitivity test was applied on Samples on which bacterial growth was identified using Clinical Laboratory Standards Institute (CLSI) guidelines. The data was analyzed using SPSS version 25. Results: Total 361 patients were enrolled in the study according to inclusion criteria, out of which, 30 (8.3%) were infants (&lt;1 years old), 178 (49.3%) were aged 1 to 5 years and 153 (42.4%) were aged from 5 to 12 years of age. Out of 361 patients, 125 (34.6%) patients were males and 236 (65.4%) were females. Out of 124 patients, whose urine culture was positive, most common pathogen was E. coli that was observed in 92 (25.5%) cases, followed by Klebsialla in 9 (2.5%) and enterococcus in 9 (2.5%) patients, Pseudomonas in 5 (1.4%), Proteus in 4 (1.1%), Mirabilis in 4 (1.1%), Acinobacter in 2 (0.6%), and enterobacter in 2 (0.6%) cases. Spectrum of sensitivity of 17 drugs was studied. The most sensitive drug was Imipenem, (29.9%), followed by Nitrofurantoin, Fosfomycin (25.8%), Amikacin (24.1%), Piperacilin / Tazobactam (22.7%). Conclusion: Thus E. coli was the most common pathogen and the most sensitive drug was Imipenem, followed by Nitrofurantoin, Fosfomycin, Amikacin, and Piperacilin / Tazobactam.

Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux.

We present updated, evidence-based clinical practice guidelines from the Indian Society of Pediatric Nephrology (ISPN) for the management of urinary tract infection (UTI) and primary vesicoureteric reflux (VUR) in children. These guidelines conform to international standards; Institute of Medicine and AGREE checklists were used to ensure transparency, rigor, and thoroughness in the guideline development. In view of the robust methodology, these guidelines are applicable globally for the management of UTI and VUR. Seventeen recommendations and 18 clinical practice points have been formulated. Some of the key recommendations and practice points are as follows. Urine culture with > 104 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong. Urine leukocyte esterase and nitrite can be used as an alternative screening test to urine microscopy in a child with suspected UTI. Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7-10days. An acute-phase DMSA scan is not recommended in the evaluation of UTI. Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2years of age with non-E. coli UTI. Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3-5) VUR. Antibiotic prophylaxis is not indicated in children with a normal urinary tract after UTI. Prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR. In children with VUR, prophylaxis should be stopped if the child is toilet trained, free of BBD, and has not had a UTI in the last 1year. Surgical intervention in high-grade VUR can be considered for parental preference over antibiotic prophylaxis or in children developing recurrent breakthrough febrile UTIs on antibiotic prophylaxis.

Investigation of Virulence Factors, Phylogenetic Group Features, and the Presence of ST131 Clone in Escherichia coli Isolates, a Urinary Tract Infection Agent in Children

Urinary tract infection (UTI) caused by Escherichia coli is a significant health issue in children. Today especially E.coli O25b/ST131, defined as a pandemic clone, is a serious public health problem due to its high virulence and antimicrobial resistance rates. In this study, a total of 200 (100 first and 100 recurrent UTI-causing) E.coli isolates from urine samples sent to the Ankara University School of Medicine Cebeci Training and Research Hospital Central Laboratory between January and September 2021 with the preliminary diagnosis of UTI in pediatric patients aged three to 18 years were analyzed for antimicrobial resistance rates, phylogenetic group distributions, virulence factor frequencies and whether they belong to the O25b/ST131 clone. It is aimed in this study that, the obtained data will shed light on new studies for diagnosis, treatment and prophylaxis options that can be developed for more effective UTI management by contributing to the surveillance studies in our country. Antimicrobial susceptibility of E.coli isolates identified by conventional methods was evaluated by Kirby-Bauer disc diffusion method and extended spectrum beta-lactamase (ESBL) production was evaluated by double disc synergy test. Polymerase chain reaction (PCR) was used for the investigation of phylogenetic grouping, the O25b/ST131 clone, virulence genes and the molecular level classification of the isolates detected as uropathogenic E.coli (UPEC). Pulsed-field gel electrophoresis (PFGE) was performed with the isolates collected at different times from the same patient. The highest antimicrobial resistance rates observed were against ampicillin (n= 100, 50%), cefazolin (n= 99, 49.5%), trimethoprim-sulfamethoxazole (n= 55, 27.5%), amoxicillin-clavulanic acid (n= 43, 21.5%) and cefotaxime (n= 43, 21.5%). In recurrent UTI agents, resistance rates were higher for cefotaxime (n= 29, 29%), trimethoprim-sulfamethoxazole (n= 35, 35%) and cefepime (n= 25, 25%) and in O25b/ST131 isolates (n= 67) the rates were higher for amikacin (n= 3, 4.5%), gentamicin (n= 10, 14.9%) and ciprofloxacin (n= 17, 25.4%) when compared to the first UTI agents and non-O25b/ ST131 isolates (p< 0.05). It was found that 29% (n = 58) of the isolates were multidrug resistant (MDR) and 19% (n = 38) produced ESBL.The rate of recurrent UTI agents was found to be higher among ESBL producing isolates and/or MDR isolates (n= 36, 62% and n= 27, 71%, respectively, p< 0.05). It was found that 45.5% (n= 91) of the isolates were in D, 37.5% (n= 75) in B2, 12.5% (n= 25) in A, and 4.5% (n= 9) in B1 phylogenetic groups and isolates belonging to B2 and D phylogenetic groups had higher antibiotic resistance rates and carried more virulence genes (p< 0.05). Of the isolates, 33.5% (n= 67) were found to belong to the O25b/ST131 clone, no significant difference was found between the O25b/ST131 rates among the first and recurrent UTI agents (p> 0.05). It was determined that the isolates most frequently carry virulence genes for adhesion [fimH 97% (n= 194), papA 57% (n= 114), yfcV 49.5% (n= 99)] and iron uptake systems [fyuA 85.5% (n= 171), chuA 78% (n= 156), iutA 73% (n= 146)]. All virulence factors were detected more frequently in isolates belonging to the O25b/ST131 clone (p< 0.05). Of the isolates, 97% (n= 65) belonging to the O25b/ST131 clone and 27.1% (n= 36) not belonging to this clone were defined as UPEC with molecular analysis (p< 0.0001). Thirty-three isolates belonging to 15 patients were evaluated with PFGE, and it was observed that the latter isolate and the first isolate of eight patients (53%) had the same band profile. Focusing on surveillance, diagnostic testing, treatment algorithms, and preventive measures for E.coli and especially for ST131 clone, which is frequently observed as causative agent in childhood UTIs, will help to manage challenging E.coli infections.

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

Extended-spectrum β-lactamases-producing Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis (ESBL-producing-EKP) are an increasingly common cause of childhood urinary tract infection (UTI) worldwide. Recognizing the risk factors and antimicrobial resistance patterns may guide new management in this population. This is a retrospective cohort study of over 5 years in Taiwan (2017-2021). Inclusion criteria are hospitalized pediatric patients with the discharge diagnosis of UTI caused by E. coli, Klebsiella pneumoniae, or Proteus mirabilis. ESBL-producing-EKP and non-ESBL-producing-EKP UTI cases were reviewed for characteristics, urinary isolate antibiotics resistance, and clinical outcomes. The incidence rate of ESBL-producing-EKP UTI increased over the study period (Overall incidence rate: 14.1%, 46/327 patients). Recent antibiotic therapy in ≤6 months (X2=11.83, p<0.01) and a preterm gestational history (X2=8.11, p<0.05) were associated with an increased risk. The proportion of patients with these two risk factors for ESBL acquisition were 37.5% (X2=9.08, p<0.05). The co-resistance rate of ESBL-producing-EKP to other antimicrobial agents was 63.0% for gentamicin, 56.5% for trimethoprim-sulfamethoxazole, 52.2% for ciprofloxacin, 4.3% for amikacin, and 2.2% for imipenem. The generalized linear model analysis identified a significantly longer length of stay (β: 2.85; 95% confidence interval [CI]: 1.14-4.56; p<0.01) and intensive care unit duration (β: 5.86; 95% CI: 1.59-10.12; p<0.01) among patients with ESBL-producing-EKP UTI. Amikacin should be considered as an alternative antimicrobial choice beyond carbapenems for ESBL-producing-EKP UTI, especially in the context of carbapenem-resistant E. coli/Klebsiella pneumoniae (CRE/CRKP) emergence.

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.

Diagnostic guidelines after urinary tract infection in children

Diagnostic guidelines after urinary tract infection in children