Pathogen distribution and antimicrobial resistance in simple and complicated urinary tract infections in pediatric patients.

BACKGROUND: We assessed pathogens, risk factors, and antibiotic non-susceptibility (ANS) rates in order to optimize the empiric antibiotic therapy for children and adolescents admitted with urinary tract infection (UTI). METHODS: A retrospective case-control study was conducted on children and adolescents aged 3 months to 18 years discharged with a complicated UTI (cUTI) diagnosis from two Israeli tertiary care pediatric centers (2018–2021). The control group included children and adolescents diagnosed with simple UTIs (sUTI) during the study period. RESULTS: 234 children with a mean age of 3.8 years were included. Male sex and previous antibiotic treatment in the last 3 months (therapeutic and prophylactic) were significantly higher in the cUTI group (26.8% vs. 11.2%. and 59.8% vs. 9.9%, respectively). Escherichia coli was the most common pathogen, especially in sUTIs, while cUTIs showed a more diverse profile, including Pseudomonas aeruginosa. cUTIs were independent predictors of multidrug-resistant (MDR) and extended-spectrum b lactamases (ESBL) producing bacteria that comprise 23% of the enterobacteria in this group, CONCLUSIONS: Our findings emphasize the need for empirical treatment for cUTIs that include antipseudomonal agents and ESBL coverage. Cephalosporins are not optimal empiric treatment in this group, while amikacin demonstrated 100% susceptibility, making it more appropriate for initial empiric therapy. Ongoing surveillance is warranted to monitor antimicrobial resistance and guide appropriate empiric treatment.