Trends in Antibiotic Resistance in Community-acquired Urinary Tract Infections Among Children: Nationwide Survey.

Background: Urinary tract infection (UTI) is one of the most common bacterial infections in children. Early antibiotic treatment may prevent complications. Empirical treatment requires up-to-date knowledge of the local epidemiology. This study aims to describe trends in resistance rates in community-acquired UTI between 2017 and 2023, assess whether current recommendations for empirical treatment are valid and identify risk factors for resistance.

Methods: Data were collected retrospectively from the computerized system of Maccabi Health Services for all children under 18 years old diagnosed with a UTI in 2017, 2022 and 2023. Data was evaluated using chi-square tests and regression models to identify resistance trends and associated risk factors.

Results: A total of 24,592 urinary samples were included in the study. Escherichia coli was the most frequently isolated pathogen (76%-78%), with higher prevalence among females than males (78.3% vs. 59.3%, P < 0.001). Sensitivity to first-generation cephalosporins improved significantly (73% in 2017 to 82% in 2022, P < 0.001), while second- and third-generation cephalosporins showed minor fluctuations. Resistance to fluoroquinolones increased markedly, from 7% to 20% (P < 0.001). Female gender, older age, prior antibiotic use and urinary tract abnormalities were significant risk factors for resistance.

Conclusions: The increased resistance rate observed for most pathogens and antibiotics was statistically significant. Nevertheless, due to small absolute changes, the recommendations for empirical antibiotic treatment in Israel are still valid. Fluoroquinolones, which are not recommended as empirical treatment, should be avoided due to high levels of resistance.