Urinary tract infections in children: clinical and antimicrobial resistance data from Bucharest area, Romania

Introduction Urinary tract infections (UTIs) are among the most common bacterial diseases of childhood with an increased frequency in infants and young children. Methods We conducted a retrospective study of children diagnosed with UTI in the Alessandrescu-Rusescu National Institute for Mother and Child Health, Bucharest, Romania between January 2017 and December 2019. We evaluated the patients' clinical characteristics, laboratory parameters and the resistance profile of the identified uropathogens. Results A total of 264 children were included in the analysis. Females (71.6%, n=186) and infants (52.7%, n=139) were more commonly affected. The recurrence rate was 27.7% and was positively associated with the presence of renal malformations. Age under 1-year, increased leukocyte and neutrophil counts, and elevated C-reactive protein were associated with hospitalization. E. coli (80.3%, n=212) was the main etiological agent isolated, followed by Proteus mirabilis (9.8%, n=26) and Klebsiella spp. (6.4%, n=17). We identified increased resistance for all germs to common antibiotics used in pediatrics: ampicillin, amoxicillin/clavulanate, cefuroxime, ceftriaxone, and trimethoprim/sulfamethoxazole. Conclusions We identified an increased resistance of uropathogens to antimicrobials commonly used in children. Reporting antimicrobial resistance from real- world clinical practice is necessary for accurate mapping and continuous updating of initial treatment recommendations until antibiogram results are received. In Romania and other countries, extensive studies are needed to follow up uropathogen resistance in both children and adults.