Urinary tract infections among children under age 3: distribution of pathogens, evolution of antimicrobial resistance, and clinical implications
Abstract
Objective: To investigate the distribution of pathogens causing urinary tract infections (UTIs) in children aged 3 years and younger, the changes in antimicrobial resistance, and the clinical significance of these findings.
Methods: A retrospective analysis was conducted on 727 pediatric patients aged 3 years and younger who were admitted to the Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital for UTIs between January 2021 and December 2023. The distribution of causative pathogens and trends in antimicrobial resistance patterns were investigated.
Results: Among the 727 pediatric patients, 408 (56.12%) presented with fever, 23 (3.16%) exhibited irritative urinary tract symptoms, and 31 (4.26%) presented with atypical symptoms. Imaging studies revealed abnormalities in 130 children (17.88%). Urine culture isolated 220 Gram-positive bacterial strains (30.26%), 409 Gram-negative bacterial strains (56.26%), and 98 fungal strains (13.48%). In particular, resistance of Enterococcus faecalis to ampicillin, ciprofloxacin, and levofloxacin, as well as resistance of Klebsiella pneumoniae to ticarcillin/clavulanic acid, showed decreasing trends.
Conclusion: The primary clinical symptom of UTIs in children aged 3 years and younger is fever, and the main causative pathogens are Gram-negative bacteria. Multidrug-resistant strains are primarily Enterobacteriaceae that produce extended-spectrum β-lactamases.
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