Etiological Profiles and Antibiotic Resistance of Urinary Tract Infections Among Different Age Categories in Children: A Retrospective Study of Xiamen Single-Center.

PURPOSE: To analyze the distribution of pathogens and drug resistance in children with urinary tract infections (UTIs) in a single center in Xiamen and to guide the selection of empirical antibiotics in the clinic.

METHODS

Clinical data of 2001 children with UTIs in Xiamen Children's Hospital between 2014 and 2022 were retrospectively analyzed, grouped by age and comorbidities. Differences in pathogen distribution and drug sensitivity were compared with the chi-square test applied and significance set at p < 0.05.

RESULTS

Of 2001 urine samples collected, 965 (42.73%) had positive results for common infections. Gram-negative bacteria predominated (644/965; 66.74%), with Escherichia coli being the most prevalent (432/965; 44.77%). The top five pathogens were Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa. The percentage of Escherichia coli was higher in simple UTIs than complex (54.01% vs 45.35%), and Pseudomonas aeruginosa (9.59% vs 2.74%) and fungi (7.27% vs 1.96%) were higher in complex UTIs (p < 0.05). Predominance of Pseudomonas aeruginosa and Enterococcus faecalis in boys and Enterococcus faecalis in girls. Escherichia coli had a significantly lower rate of resistance to ampicillin than Klebsiella pneumoniae (p < 0.001), and both had a high rate of resistance to cephalosporins (over 95% to cefazolin), but a low rate of resistance to amikacin and furotoxin. Pseudomonas aeruginosa had 100% resistance to most cephalosporins, but less than 7% to ceftazidime, cefepime and piperacillin tazobactam. Enterococcus faecalis had over 90% resistance to Ampicillin, Penicillin, Linezolid and 91.53% to tetracycline. No Tigecycline/Vancomycin-resistant enterococci were found. Both Gram-negative and Gram-positive bacteria maintained relatively low rates of resistance to Nitrofurantoin.

CONCLUSION

Pediatric UTIs in Xiamen show gender-based pathogen differences, mainly gram-negative. Nitrofurantoin is preferred for mild cases, and the clinical selection should be individualized by combining the regional pathogen spectrum and drug sensitivity.