Comparative Clinical and Microbiological Profile of Non-Escherichia Coli Uropathogens Versus Escherichia Coli in Pediatric Community-Acquired Urinary Tract Infections

Abstract

Objective

To compare the clinical characteristics, antimicrobial susceptibility patterns, multidrug resistance (MDR), extended-spectrum β-lactamase (ESBL) production, and empirical antibiotic discordance between Escherichia coli and non-E. coli community-acquired urinary tract infections (UTIs) in children.

Methods

This prospective observational study included children aged 0–12 years with symptomatic, culture-confirmed community-acquired UTI presenting to a tertiary-care pediatric centre in New Delhi between November 2020 and August 2022. Participants were classified according to the isolated pathogen as E. coli or non-E. coli. Demographic and clinical characteristics, antimicrobial susceptibility, ESBL/MDR status, empirical antibiotic use, and treatment modification were recorded. The primary outcome was empirical antibiotic discordance, defined as resistance of the isolated pathogen to the initially administered empirical antibiotic.

Results

Among 64 culture-positive UTI episodes, 51 (79.7%) were caused by E. coli and 13 (20.3%) by non-E. coli organisms. Recurrent UTI was more frequent in non-E. coli infections than E. coli infections (46.2% vs. 31.4%). Among 57 episodes receiving empirical antibiotics, discordance occurred in 13 (22.8%), being more frequent with non-E. coli than E. coli infections (41.7% vs. 17.8%). High resistance was observed to cefixime and ceftriaxone, whereas nitrofurantoin, fosfomycin and amikacin retained higher activity. ESBL production was detected in 21/42 (50.0%) tested isolates.

Conclusions

Non-E. coli organisms accounted for approximately one-fifth of community-acquired pediatric UTIs and were associated with greater empirical antibiotic discordance. Local susceptibility data and timely culture-directed therapy are important for appropriate empirical antibiotic selection.