An observational study on multidrug resistance in pediatric patients with urinary tract infections.

Pediatric urinary tract infections (UTIs) are a common cause of morbidity, with Escherichia coli as the leading pathogen. Rising antimicrobial resistance (AMR) complicates management, particularly in resource-limited settings where data is scarce. A cross-sectional study was conducted over six months among 80 children (< 18 years) with culture-confirmed UTIs at a tertiary care hospital. Uropathogens were identified using standard biochemical and automated methods, and antibacterial susceptibility was assessed by VITEK 2 and disk diffusion per CLSI guidelines. Multidrug resistance (MDR) was defined as resistance to ≥ 1 agent in ≥ 3 antibacterial classes. UTIs were most frequent in early childhood (62.5%), with a higher prevalence in females (58.8%). Gram-negative organisms accounted for 81.3% of isolates. Escherichia coli (58.8%) was the predominant uropathogen, followed by Enterococcus spp. (17.5%) and Klebsiella pneumoniae (10.0%). Escherichia coli demonstrated high resistance to nalidixic acid (84.4%), ampicillin (78.1%), and ciprofloxacin (78.1%), while maintaining high susceptibility to fosfomycin (90.6%), ertapenem (81.3%), gentamicin (71.9%), and nitrofurantoin (71.9%). Enterococcus spp. exhibited high resistance to tetracycline (64.3%), and levofloxacin (63%). but remained sensitive to linezolid (93.27%), vancomycin (85.71%), teicoplanin (78.57%), and tigecycline (71.4%). A substantial proportion of isolates were multidrug-resistant, limiting therapeutic options. Escherichia coli remains the leading cause of Pediatric UTIs, but high resistance to commonly prescribed antibacterials underscores the need for cautious empirical therapy. Fosfomycin, nitrofurantoin, and carbapenems retain efficacy, though over-reliance may accelerate resistance. Regular, pediatric-specific AMR surveillance and antimicrobial stewardship programs are essential to preserve treatment efficacy and improve outcomes in this vulnerable population.