Antimicrobial Resistance in Pediatric Urinary Tract Infections: Resistance Patterns, Therapeutic Challenges, and Strategies for Optimizing Antibiotic Treatment
DOI:
https://doi.org/10.70577/6zdkb121Keywords:
Urinary tract infection; antimicrobial resistance; pediatrics; Escherichia coli; extended-spectrum beta-lactamases.Abstract
Introduction: Urinary tract infections (UTIs) are among the most common bacterial infections in children and are one of the leading causes of medical consultations, as well as antibiotic use and hospitalization; Various studies in recent years have shown an increase in antimicrobial resistance, particularly in pathogens such as E. coli, which has created challenges in empirical treatment and led to higher rates of treatment failure, as well as recurrent infections and long-term renal complications. Objective of the study: To analyze bacterial resistance in urinary tract infections in the pediatric population, identifying the most common microorganisms involved, as well as the factors associated with the development of the infection and the impact of diagnosis and treatment. Methodology: A narrative literature review was conducted using scientific articles published in databases such as Scopus, SciELO, Google Scholar, and PubMed. The review included original studies, as well as literature reviews and scientific articles related to pediatric urinary tract infections, antimicrobial resistance, treatment of children with urinary tract infections, and bacterial resistance mechanisms. Publications from the past 5 years with clinical and scientific relevance were selected. Key findings: It was found that Escherichia coli is the primary causative agent of UTIs in both the adult and pediatric populations. Furthermore, there has been a progressive increase in strains resistant to commonly used antibiotics such as ampicillin, trimethoprim/sulfamethoxazole, and cephalosporins—primarily third-generation cephalosporins. The production of extended-spectrum beta-lactamases (ESBLs) is one of the main mechanisms of resistance due to its ability to limit treatment options. Other associated factors include antibiotic use, recurrent infections, hospitalization, and congenital anomalies of the urinary tract. Conclusion: Antimicrobial resistance is a challenge in the management of pediatric urinary tract infections, and significant clinical repercussions have been demonstrated; therefore, microbiological surveillance, the rational use of antibiotics, and tailoring treatment to each patient’s specific circumstances are strategies that must be implemented to improve patient recovery and prognosis.
Downloads
References
- Albarrak, M., Alzomor, O., Almaghrabi, R., Alsubaie, S., Alghamdi, F., Bajouda, A., Nojoom, M., Faqeehi, H., Rubeea, S. A., Alnafeesah, R., Dolgum, S., ALghoshimi, M., AlHajjar, S., & AlShahrani, D. (2021). Diagnosis and management of community-acquired urinary tract infection in infants and children: Clinical guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS). International Journal of Pediatrics and Adolescent Medicine, 8(2), 57–67. https://doi.org/10.1016/j.ijpam.2021.03.001 DOI: https://doi.org/10.1016/j.ijpam.2021.03.001
- Albañil Rosa; Cubero Ana; Martinez José. (2024). Etiología y resistencia a los antibióticos en la infección urinaria pediátrica. Estudio multicéntrico desde Atención Primari. Rev pediatr Aten Primaria, 26(104). https://doi.org/https://doi.org/10.60147/5d2a9a33 DOI: https://doi.org/10.60147/5d2a9a33
- Celep, G., & Özçelik, H. B. (2021). Evaluation of clinical, etiological and antimicrobial resistance profile of pediatriurinary tract infections in a secondary health care centre. African Health Sciences, 21(2), 557–565. https://doi.org/10.4314/ahs.v21i2.10 DOI: https://doi.org/10.4314/ahs.v21i2.10
- Correoso-Salazar, S., Leticia Bello-Fernández, Z., Pacheco-Pérez, Y., & Cozme-Rojas, Y. (n.d.). ARTÍCULO ORIGINAL Antimicrobial resistance in pediatric patients with urinary infections. Retrieved http://revzoilomarinello.sld.cu/index.php/zmv/article/view/3077.
- Esposito, S., Biasucci, G., Pasini, A., Predieri, B., Vergine, G., Crisafi, A., Malaventura, C., Casadio, L., Sella, M., Pierantoni, L., Gatti, C., Paglialonga, L., Sodini, C., La Scola, C., Bernardi, L., Autore, G., Canto, G. D., Argentiero, A., Cantatore, S., … Iughetti, L. (2022). Antibiotic Resistance in Paediatric Febrile Urinary Tract Infections. In Journal of Global Antimicrobial Resistance (Vol. 29, pp. 499–506). Elsevier Ltd. https://doi.org/10.1016/j.jgar.2021.11.003 DOI: https://doi.org/10.1016/j.jgar.2021.11.003
- Farfan, A. B. P., de Barrón, Y. L. M., Yarihuamán, M. M. M., Laines, F. M. P., Pérez, M.
B. P., Choque, J. S. C., & Pastor, H. J. B. (2025). Phylogenetic Analysis of Escherichia coli according to Phenotypic Resistance in Urinary Tract Infections in Children, Lima, Peru. Infection and Chemotherapy, 57(1), 93–101. https://doi.org/10.3947/ic.2024.0101 DOI: https://doi.org/10.3947/ic.2024.0101
- Gnech, M., ’t Hoen, L., Zachou, A., Bogaert, G., Castagnetti, M., O’Kelly, F., Quaedackers, J., Rawashdeh, Y. F., Silay, M. S., Kennedy, U., Skott, M., van Uitert, A., Yuan, Y., Radmayr, C., & Burgu, B. (2024). Update and Summary of the European Association of Urology/European Society of Paediatric Urology Paediatric Guidelines on Vesicoureteral Reflux in Children. In European Urology (Vol. 85, Number 5, pp. 433–442). Elsevier B.V. https://doi.org/10.1016/j.eururo.2023.12.005 DOI: https://doi.org/10.1016/j.eururo.2023.12.005
- Isac, R., Basaca, D. G., Olariu, I. C., Stroescu, R. F., Ardelean, A. M., Steflea, R. M., Gafencu, M., Chirita-Emandi, A., Cristina Bagiu, I., Horhat, F. G., Vulcanescu, D. D.,
Ionescu, D., & Doros, G. (2021). Antibiotic resistance patterns of uropathogens causing urinary tract infections in children with congenital anomalies of kidney and urinary tract. Children, 8(7). https://doi.org/10.3390/children8070585 DOI: https://doi.org/10.3390/children8070585
- Isac, R., Doros, G., Stolojanu, C. A., Steflea, R. M., Stroescu, R. F., Olariu, I. C., Micsescu-Olah, A. M., & Gafencu, M. (2024). General Characteristics and Current State of Antibiotic Resistance in Pediatric Urinary Tract Infection—A Single Center Experience. Antibiotics,
13(8). https://doi.org/10.3390/antibiotics13080684 DOI: https://doi.org/10.3390/antibiotics13080684
- Lebowitz, R. L., Olbing, H., Parkkulainen, K. V., Smellie, J. M., & Tamminen-Möbius, T.
E. (1985). International system of radiographic grading of vesicoureteric reflux. Pediatric Radiology, 15(2), 105–109. https://doi.org/10.1007/BF02388714 DOI: https://doi.org/10.1007/BF02388714
- Kurowski, K. M., Marusinec, R., Amato, H. K., Saraiva-Garcia, C., Loayza, F., Salinas, L., Trueba, G., & Graham, J. P. (2021). Social and environmental determinants of community-acquired antimicrobial-resistant Escherichia coli in children living in semirural communities of Quito, Ecuador. American Journal of Tropical Medicine and Hygiene, 105(3), 600–610. https://doi.org/10.4269/ajtmh.20-0532 DOI: https://doi.org/10.4269/ajtmh.20-0532
- MARINESCU, A.-D., MARINESCU, M.-C., MOISA, S.-M., & CINTEZA, E.-E. (2026).
Urinary Tract Infections in Children – Microbiological Challenges and Mechanisms of Bacterial Resistance. Maedica - A Journal of Clinical Medicine, 21(1). https://doi.org/10.26574/maedica.2026.21.1.147 DOI: https://doi.org/10.26574/maedica.2026.21.1.147
- Micieli, M., Boncompagni, S. R., Di Maggio, T., Ramos, Y. B. M., Mantella, A., Villagrán,
A. L., Yelma, C. A. R., Fernández, E. E. F., Spinicci, M., Strohmeyer, M., Pallecchi, L., Rossolini, G. M., & Bartoloni, A. (2025). The Etiology and Antimicrobial Susceptibility of Community-Onset Urinary Tract Infections in a Low-Resource/High-Resistance Area of Latin America. Tropical Medicine and Infectious Disease, 10(3). https://doi.org/10.3390/tropicalmed10030064 DOI: https://doi.org/10.3390/tropicalmed10030064
- Monroy-Higuera, J., Angulo-Zamudio, U. A., Leon-Sicairos, N., Flores-Villaseñor, H., Velazquez-Roman, J., Ruiz-Trejo, E., Medina-Serrano, J., Castro-Apodaca, F., Tapia-Pastrana, G., & Canizalez-Roman, A. (2026). Epidemiological and Clinical Characteristics Associated with Antimicrobial-Resistant Urinary Tract Infections in Outpatient and Inpatient Settings: A Retrospective Study from Northwestern Mexico. Pathogens, 15(1), 92. https://doi.org/10.3390/pathogens15010092 DOI: https://doi.org/10.3390/pathogens15010092
- Oliva Falcón, A. (2024). Resistencia bacteriana y detección de β-lactamasas en niños ingresados por infección del tracto urinario. https://orcid.org/0000-0001-8425-9068
- Potvin, E., Adams, K., Barrieras, D., Bolduc, S., & Quach, C. (2024). Impact of antibiotic prophylaxis on urinary tract infection recurrence in children. In Canadian Urological Association Journal (Vol. 18, Number 12, pp. E387–E396). Canadian Urological Association. https://doi.org/10.5489/cuaj.8678 DOI: https://doi.org/10.5489/cuaj.8678
- Rosado, M. R., Molina, A. G., Velasco, A. L., Chinchilla, G. C., Lana, P. V., La Orden Izquierdo, E., & Vidal, L. S. (2022). Urinary Tract Infection in Pediatrics: Study of Uropathogens and Their Resistance in a Madrid Hospital. Archivos Espanoles de Urologia, 75(9), 791–797. https://doi.org/10.56434/j.arch.esp.urol.20227509.115 DOI: https://doi.org/10.56434/j.arch.esp.urol.20227509.115
- Samreen, Ahmad, I., Malak, H. A., & Abulreesh, H. H. (2021). Environmental antimicrobial resistance and its drivers: a potential threat to public health. In Journal of Global Antimicrobial Resistance (Vol. 27, pp. 101–111). Elsevier Ltd. https://doi.org/10.1016/j.jgar.2021.08.001 DOI: https://doi.org/10.1016/j.jgar.2021.08.001
- Sandigo Rosales, S. L., Valdivia Quiroz, S. K., & Mayorga Marín, F. J. (2025). Resistencia antibiótica de Escherichia coli en infección del tracto urinario en pacientes pediátricos: Una revisión bibliográfica. Revista Ciencias de La Salud y Educación Médica, 7(11), 50–57. https://doi.org/10.5377/rcsem.v7i11.20630 DOI: https://doi.org/10.5377/rcsem.v7i11.20630
- Saqan, R., Tayyem, M., Alathirah, M., Jarrar, A. M., Muhsen, R. M., Hayajneh, W., & Abuzenah, Y. A. (2026). Prevalence of Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase Escherichia coli, a Tertiary Center Nine-Year Comparison. Infection and Drug Resistance, 19. https://doi.org/10.2147/IDR.S581937 DOI: https://doi.org/10.2147/IDR.S581937
- Schaffer, J. N., & Pearson, M. M. (2015). Proteus mirabilis and Urinary Tract Infections . Microbiology Spectrum, 3(5). https://doi.org/10.1128/microbiolspec.uti-0017-2013 DOI: https://doi.org/10.1128/microbiolspec.UTI-0017-2013
- Shkalim Zemer, V., Ashkenazi, S., Levinsky, Y., Richenberg, Y., Jacobson, E., Nathanson, S., Shochat, T., Kushnir, S., Cohen, M., & Cohen, A. H. (2024). Pathogens Causing Pediatric Community Acquired Urinary Tract Infections and Their Increasing Antimicrobial Resistance: A Nationwide Study. Pathogens, 13(3). https://doi.org/10.3390/pathogens13030201 DOI: https://doi.org/10.3390/pathogens13030201
- Spencer, J. D., Schwaderer, A. L., Wang, H., Bartz, J., Kline, J., Eichler, T., Desouza, K. R., Sims-Lucas, S., Baker, P., & Hains, D. S. (2013). Ribonuclease 7, an antimicrobial peptide upregulated during infection, contributes to microbial defense of the human urinary tract. Kidney International, 83(4), 615–625. https://doi.org/10.1038/ki.2012.410 DOI: https://doi.org/10.1038/ki.2012.410
- Tamas, V., Ulloa, E. R., Kumaraswamy, M., Dahesh, S., Zurich, R., Nizet, V., & Coady, A. (2025). Extended-Spectrum β-Lactamase-Producing Escherichia coli and Pediatric UTIs: A Review of the Literature and Selected Experimental Observations. In Antibiotics (Vol. 14, Number 12). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/antibiotics14121284 DOI: https://doi.org/10.3390/antibiotics14121284
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Clara Marianela Paredes Toasa, María Paula Villagomez Mayorga, Juan Sebastián Cahuasqui Llerena, Stephanie Silvana Viteri Freire, Kevin Mateo Enríquez Pineda (Autor/a)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
