Etiology and antibiotic resistance in pediatric urinary tract infection. A multicenter study from Primary Care

Introduction: empirical treatment of urinary tract infection (UTI) requires knowledge of uropathogen antibiotic resistance. This study aims to analyze the pathogens causing community pediatric UTI, their resistance rates and the relationship between resistance and the studied variables.

Patients and methods: nationwide, multicenter, descriptive, longitudinal and prospective study carried out in Primary Care pediatric clinics. All UTI episodes identified in patients belonging to 187 researcher pediatric quotas (187,058 patients, 0-15 years old) were included regardless of the healthcare setting in which they were diagnosed or treated. Data collection was carried out from 1/10/2019 to 31/12/2020.

Results: 588 UTI episodes were registered. Escherichia coli was the most common isolated uropathogen (79,67%), followed by Proteus spp., Klebsiella spp. and Enterococcus spp. Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL) were isolated in 1,52 % episodes. The oral antibiotics with the lowest resistance rates were third generation cephalosporins, cefuroxime and fosfomycin (3,88%, 4,81% y 6,30% respectively). Resistance rates to first generation cephalosporins, gentamicin and amikacin were 8,69%, 7,55% y 3,23% respectively. Resistance rate to amoxicillin-clavulanate was 23,85% (34,51% in males) and 23,40% to cotrimoxazole.

Conclusions: E. coli was the most frequent isolated uropathogen. Amoxicillin-clavulanic acid and cotrimoxazole should not be used empirically due to their high resistance rates. Second and third generation cephalosporins and fosfomycin could be adequate empirical therapy according to age and type of infection. Local susceptibility to 1st generation cephalosporins should be tested.