Background: Urinary Tract Infections (UTI) are common in children and organisms associated with UTI have shown increasing resistance to commonly used antibiotics. This study aims to evaluate common organisms causing UTI, determine their susceptibility pattern to commonly used oral antibiotics for treatment of UTI and compare trends with past studies in the same geographic region. Methods: 4-year retrospective review of positive urine cultures in children < 16 years from 2020 to 2023 in South Staffordshire and surrounding areas in the United Kingdom. Demographic data, culture results and antibiotic susceptibility were analysed using appropriate tools. Results: Among the 1818 episodes of confirmed UTI that met inclusion criteria, 87.3% were females while 12.7% were males. 67.4% UTIs were in children < 10 years. E coli accounted for 83.3% of all organisms, followed by Enterecoccus (5.6%), Klebsiella (4.6%) and Proteus (2.1%). Analysis of antimicrobial resistance rate showed E coli was highly susceptible to nitrofurantoin (95.3%) and cefalexin (92.9%) but had high resistance to trimethoprim (26.7%) and amoxicillin (42.1%). Conclusion: Coliform resistance to amoxicillin and trimethoprim remains high. Hence, these antibiotics may not be the right first-line antibiotic choice for empiric treatment of UTI in children.
Kaufman, J., Temple-Smith, M. and Sanci, L. (2019) Urinary Tract Infections in Children: An Overview of Diagnosis and Management. BMJ Paediatrics Open, 3, e000487. https://doi.org/10.1136/bmjpo-2019-000487
[3]
Butler, C.C., O’Brien, K., Pickles, T., Hood, K., Wootton, M., Howe, R., et al. (2015) Childhood Urinary Tract Infection in Primary Care: A Prospective Observational Study of Prevalence, Diagnosis, Treatment, and Recovery. British Journal of General Practice, 65, e217-e223. https://doi.org/10.3399/bjgp15x684361
[4]
Primack, W., Bukowski, T., Sutherland, R., Gravens-Mueller, L. and Carpenter, M. (2017) What Urinary Colony Count Indicates a Urinary Tract Infection in Children? The Journal of Pediatrics, 191, 259-261.e1. https://doi.org/10.1016/j.jpeds.2017.08.012
[5]
Barola, S., Grossman, O.K. and Abdelhalim, A. (2024) Urinary Tract Infections in Children. StatPearls. https://pubmed.ncbi.nlm.nih.gov/38261676/
[6]
Roberts, K.B., Downs, S.M., Finnell, S.M.E., Hellerstein, S., Shortliffe, L.D., Wald, E.R., et al. (2016) Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age. Pediatrics, 138, e20163026. https://doi.org/10.1542/peds.2016-3026
[7]
Simões e Silva, A.C., Oliveira, E.A. and Mak, R.H. (2020) Urinary Tract Infection in Pediatrics: An Overview. Jornal de Pediatria, 96, 65-79. https://doi.org/10.1016/j.jped.2019.10.006
[8]
Stultz, J.S., Francis, N., Ketron, S., Bagga, B., Shelton, C.M., Lee, K.R., et al. (2020) Analysis of Community-Acquired Urinary Tract Infection Treatment in Pediatric Patients Requiring Hospitalization: Opportunity for Use of Narrower Spectrum Antibiotics. Journal of Pharmacy Technology, 37, 79-88. https://doi.org/10.1177/8755122520964435
[9]
Ahmed, M., Long, W.N.W., Javed, S. and Reynolds, T. (2021) Rising Resistance of Urinary Tract Pathogens in Children: A Cause for Concern. Irish Journal of Medical Science (1971-), 191, 279-282. https://doi.org/10.1007/s11845-021-02531-4
[10]
Kılıç, F.E. and Küçükkelepçe, O. (2025) Evaluating Antibiotic Resistance in Pediatric Utis: Five-Year Data from a Tertiary Hospital in Turkey. Medicina, 61, Article 402. https://doi.org/10.3390/medicina61030402
[11]
Shkalim Zemer, V., Ashkenazi, S., Levinsky, Y., Richenberg, Y., Jacobson, E., Nathanson, S., et al. (2024) Pathogens Causing Pediatric Community Acquired Urinary Tract Infections and Their Increasing Antimicrobial Resistance: A Nationwide Study. Pathogens, 13, Article 201. https://doi.org/10.3390/pathogens13030201
[12]
Bryce, A., Costelloe, C., Wootton, M., Butler, C.C. and Hay, A.D. (2018) Comparison of Risk Factors for, and Prevalence of, Antibiotic Resistance in Contaminating and Pathogenic Urinary Escherichia coli in Children in Primary Care: Prospective Cohort Study. Journal of Antimicrobial Chemotherapy, 73, 1359-1367. https://doi.org/10.1093/jac/dkx525
[13]
Chakupurakal, R., Ahmed, M., Sobithadevi, D.N., Chinnappan, S. and Reynolds, T. (2010) Urinary Tract Pathogens and Resistance Pattern. Journal of Clinical Pathology, 63, 652-654. https://doi.org/10.1136/jcp.2009.074617
[14]
Marol, D.R., Kumar Marol, M.R. and Marol, D.R. (2020) Organisms Causing Urinary Tract Infections in Children and Their Sensitivity Pattern in a Level 2 Pediatric Hospital at a District Place in South India. Pediatric Review: International Journal of Pediatric Research, 7, 129-135. https://doi.org/10.17511/ijpr.2020.i03.03
[15]
Belete, Y., Asrat, D., Woldeamanuel, Y., Yihenew, G. and Gize, A. (2019) Bacterial Profile and Antibiotic Susceptibility Pattern of Urinary Tract Infection among Children Attending Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. Infection and Drug Resistance, 12, 3575-3583. https://doi.org/10.2147/idr.s217574
[16]
Hay, A.D., Sterne, J.A.C., Hood, K., Little, P., Delaney, B., Hollingworth, W., et al. (2016) Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study. The Annals of Family Medicine, 14, 325-336. https://doi.org/10.1370/afm.1954
[17]
Butler, C.C., O’Brien, K., Wootton, M., Pickles, T., Hood, K., Howe, R., et al. (2016) Empiric Antibiotic Treatment for Urinary Tract Infection in Preschool Children: Susceptibilities of Urine Sample Isolates. Family Practice, 33, 127-132. https://doi.org/10.1093/fampra/cmv104
[18]
Bean, D.C., Krahe, D. and Wareham, D.W. (2008) Antimicrobial Resistance in Community and Nosocomial Escherichia coli Urinary Tract Isolates, London 2005-2006. Annals of Clinical Microbiology and Antimicrobials, 7, Article No. 13. https://doi.org/10.1186/1476-0711-7-13
[19]
Bryce, A., Hay, A.D., Lane, I.F., Thornton, H.V., Wootton, M. and Costelloe, C. (2016) Global Prevalence of Antibiotic Resistance in Paediatric Urinary Tract Infections Caused by Escherichia coli and Association with Routine Use of Antibiotics in Primary Care: Systematic Review and Meta-Analysis. BMJ, 352, i939. https://doi.org/10.1136/bmj.i939
[20]
Gupta, K., Hooton, T.M. and Stamm, W.E. (2001) Increasing Antimicrobial Resistance and the Management of Uncomplicated Community-Acquired Urinary Tract Infections. Annals of Internal Medicine, 135, 41-50. https://doi.org/10.7326/0003-4819-135-1-200107030-00012
[21]
Parry, C., Lally, H., Taylor, A. and Corbett, H. (2023) 45 Antimicrobial Resistance of Break-Through UTI in Young Children Receiving Continuous Antibiotic Prophylaxis. Archives of Disease in Childhood, 108, A72.1-A72. https://doi.org/10.1136/archdischild-2023-rcpch.119
[22]
(2024) Confronting Antimicrobial Resistance 2024 to 2029. https://assets.publishing.service.gov.uk/media/664394d9993111924d9d3465/confronting-antimicrobial-resistance-2024-to-2029.pdf