Aetiology and antibiotic resistance in paediatric urinary tract infection. A multicentre study in primary care

Introduction: empirical treatment of urinary tract infection (UTI) requires knowledge of antibiotic resistance in the most prevalent uropathogens. The aim of the study was to analyse the pathogens involved in community-acquired paediatric UTIs, their drug resistance profile and the association between resistance and the studied variables.

Patients and methods: nationwide, multicentre, prospective, longitudinal and descriptive  study carried out in primary care paediatrics clinics. We included all UTI episodes identified in patients aged 0-15 years in the caseloads of 187 collaborating paediatricians (187 058 patients), regardless of the setting where they were diagnosed or treated, between 1/10/2019 and 31/12/2020.

Results: there were 588 identified UTI episodes. Escherichia coli was the most frequently isolated uropathogen (79.67%), followed by Proteus spp., Klebsiella spp. and Enterococcus spp. Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae were isolated in 1.52% of episodes. The lowest prevalences of resistance to oral antibiotics corresponded to third-generation cephalosporins, cefuroxime and fosfomycin (3.88%, 4.81% and 6.30%, respectively). The proportions of resistance to first-generation cephalosporins, gentamicin and amikacin were 8.69%, 7.55% and 3.23% respectively. The prevalence of resistance was 23.85% for amoxicillin-clavulanic acid (34.51% in males) and 23.40% for cotrimoxazole.

Conclusions: E. coli was the most frequently isolated uropathogen. Amoxicillin-clavulanic acid and cotrimoxazole should not be used empirically due to the high prevalence of resistance. Second and third generation cephalosporins and fosfomycin could be adequate empirical therapy depending on age and the type of infection. Local susceptibility to first-generation cephalosporins should be tested.