PEDIATRIC URINARY TRACT INFECTION MANAGEMENT IN THE ERA OF RISING ANTIBIOTIC RESISTANCE: INSIGHTS FROM A SINGLE-CENTER COHORT

Öz

Objective: Urinary tract infections (UTIs) are one of the most common bacterial infections in children and can lead to serious complications. This study aimed to investigate the clinical and microbiological characteristics of pediatric UTIs, identify factors associated with renal scarring, analyze trends in antibiotic resistance, and evaluate the impact of urinary anomalies and vesicoureteral reflux (VUR) on recurrence of infection and long-term outcomes. Material and Methods: In this retrospective study, 699 children followed up for UTI were evaluated. Clinical features, laboratory and imaging findings (Ultrasound, voiding cystourethrogram, DMSA renal scan), microbiological data, antibiotic resistance patterns and long-term complications were analyzed. Risk factors for renal scarring were assessed using multivariate logistic regression. Results: Out of the 699 patients followed for UTIs, 530 were female. The median age at the first UTI was 12 months. Renal ultrasonography was performed on all patients. Anomalies were detected in 15.7% of patients. E. coli was the predominant pathogen (82.6%). Renal scarring was detected in 15.7% of patients and was significantly associated with high-grade VUR, recurrent UTI, abnormal US findings, and fever ≥38°C. The prevalence of ESBL-producing bacteria was 2.4%, with ubstantialtly higher ciprofloxacin resistance (28%) compared to non-ESBL bacteria (7.5%). Over time, E. coli resistance to TMP-SMX and amoxicillin-clavulanate declined, whereas cefixime resistance slightly increased. Conclusion: Renal scarring in pediatric UTI is strongly associated with VUR severity, recurrent infections, and urinary tract anomalies. Antibiotic resistance remains a growing concern, particularly among ESBL-producing pathogens. Rational use of antibiotics and individualized risk-based prophylactic strategies are critical to minimizing long-term complications and resistance.

Anahtar Kelimeler

• Pediatric urinary tract infection
• vesicoureteral reflux
• renal scarring
• antibiotic resistance
• extended-spectrum beta-lactamase

Artan Antimikrobiyal Direnç Döneminde Pediatrik İdrar Yolu Enfeksiyonu Yönetimi: Tek Merkezli Bir Kohort Çalışması Bulguları

Öz

Amaç: İdrar yolu enfeksiyonları (İYE), çocuklarda en sık görülen bakteriyel enfeksiyonlar arasında yer almakta olup ciddi uzun dönem komplikasyonlara yol açabilmektedir. Bu çalışmanın amacı, pediatrik İYE’lerin klinik ve mikrobiyolojik özelliklerini değerlendirmek, renal skar oluşumu ile ilişkili risk faktörlerini belirlemek, antibiyotik direnç eğilimlerini incelemek ve üriner sistem anomalileri ile vezikoüreteral reflünün (VUR) enfeksiyon nüksü ve uzun dönem sonuçlar üzerindeki etkisini değerlendirmektir. Gereç ve Yöntemler: Bu retrospektif çalışmada, İYE nedeniyle izlenen 699 çocuk değerlendirildi. Klinik özellikler, laboratuvar sonuçları, görüntüleme bulguları (ultrasonografi, işeme sistoüretrografisi ve DMSA sintigrafisi), mikrobiyolojik veriler, antibiyotik direnç profilleri ve uzun dönem komplikasyonlar analiz edildi. Renal skar ile ilişkili risk faktörleri çok değişkenli lojistik regresyon analizi ile belirlendi. Bulgular: Çalışmaya dâhil edilen 699 hastanın 530’u kız olup, ilk İYE geçirme medyan yaşı 12 ay idi. Tüm hastalara renal ultrasonografi uygulanmış olup, olguların %15,7’sinde üriner anomaliler saptandı. Başlıca etken mikroorganizma Escherichia coli idi (%82,6). Renal skar %15,7 oranında tespit edildi ve yüksek dereceli VUR, tekrarlayan İYE, anormal ultrason bulguları ve ≥38°C ateş ile anlamlı ilişki gösterdi. Geniş spektrumlu beta-laktamaz (GSBL) üreten suş oranı %2,4 olup, bu suşlarda siprofloksasin direnci (%28), GSBL-negatiflere kıyasla (%7,5) belirgin derecede yüksekti. Zaman içinde E. coli’nin trimetoprim-sülfametoksazol ve amoksisilin-klavulanat direncinde azalma görülürken, sefiksim direncinde hafif bir artış izlendi. Sonuç: Pediatrik İYE’de renal skar gelişimi, VUR derecesi, tekrarlayan enfeksiyonlar ve üriner sistem anomalileri ile güçlü şekilde ilişkilidir. Zaman içinde direnç paternleri değişmekle birlikte, GSBL üreten patojenler önemli bir sorun olmaya devam etmektedir. Uzun dönem komplikasyonları ve antimikrobiyal direnç gelişimini azaltmak için antibiyotiklerin akılcı kullanımı ve bireyselleştirilmiş, risk temelli profilaktik yaklaşımlar büyük önem taşımaktadır.

Anahtar Kelimeler

• Pediatrik idrar yolu enfeksiyonu
• vezikoüreteral reflü
• böbrek skarlaşması
• antibiyotik direnci
• geniş spektrumlu beta-laktamaz

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