A total of 840 pediatric patients including 569 males and 271 females were hospitalized for UTI in our center, indicating that the male to female ratio was 2.10:1. The age of UTI children in this study ranges from 1 month to 14 years. From 840 pediatric patients, 694 (82.62%) children were diagnosed with complicated UTI and the remaining 146 (17.38%) children were simple UTI. The general characteristics of patients are shown in Table 1.
Variables
|
Total UTI (N=840)
|
Complicated UTI (N=694)
|
Simple UTI (N=146)
|
Age( in years)
|
≤1y
|
458
|
403
|
55
|
1-5y
|
204
|
149
|
55
|
≥5y
|
178
|
142
|
36
|
Gender
|
Male
|
569
|
485
|
84
|
Female
|
271
|
209
|
62
|
Mode of delivery
|
Vaginal delivery
|
469
|
386
|
83
|
Caesarean delivery
|
371
|
308
|
63
|
Birth weight
|
Low (<2500g).
|
34
|
25
|
9
|
Normal (2500-4000g)
|
778
|
656
|
122
|
High (>4000g)
|
28
|
13
|
15
|
Feeding pattern
|
Breast feeding
|
496
|
398
|
98
|
Artificial feeding
|
204
|
182
|
22
|
Mixed feeding
|
140
|
114
|
26
|
Premature delivery (<37weeks)
|
Yes
|
34
|
28
|
6
|
No
|
806
|
666
|
140
|
Primigravida
|
Yes
|
401
|
320
|
81
|
No
|
439
|
374
|
65
|
Ureteral stent or catheter
|
Yes
|
213
|
213
|
0
|
No
|
627
|
481
|
146
|
Clinical presentation
|
Yes
|
481
|
340
|
141
|
No
|
359
|
354
|
5
|
History of surgery
|
Yes
|
294
|
294
|
0
|
No
|
546
|
400
|
146
|
Table 1. Clinical characteristics of study participants by diagnosis of UTI.
The proportion of culture-positive UTI was 54.52% (458/840) with majority of the isolates being Gram-negative bacteria. There were 694 children with complicated UTI in those children. 30 of these 694 patients (4.32%) had urinary stones and 664 had urogenital abnormalities (95.68%). Abnormalities of the genitourinary tract included VUR, duplicated collecting system, PUV, NB, ureteral obstruction and UPJO. Consequently, the proportion of culture-positive UTI was 397/694 (57.20%). Gram-negative bacteria mainly included Escherichia coli 121 (30.48%), Klebsiella pneumoniae 32(8.06%), Pseudomonas aeruginosa 20 (5.04%), Enterobacter cloacae 11 (2.77%) and Citrobacter 13 (3.28%). The isolated Gram-positive bacteria mainly contained Enterococcus faecalis (14.61%) and Enterococcus faecium (16.62%). In addition, there were 146 children diagnosed simple UTI. We detected that the proportion of culture-positive UTI was 61/146 (41.78%). The predominant bacteria were Escherichia coli (73.77%, 45/61) followed by Enterococcus faecium and CoNS (each 6.56%) (Table 2).
Isolates
|
Total UTI (N=458)
|
Simple UTI (N=61)
|
Complicated UTI (N=397)
|
Escherichia coli
|
166
|
45
|
121
|
Enterococcus faecium
|
70
|
4
|
66
|
Enterococcus faecalis
|
59
|
1
|
58
|
Klebsiella pneumoniae
|
33
|
1
|
32
|
Pseudomonas aeruginosa
|
20
|
0
|
20
|
Citrobacter
|
14
|
1
|
13
|
CoNS
|
19
|
4
|
15
|
Proteus mirabilis
|
12
|
2
|
10
|
Enterobacter cloacae
|
13
|
2
|
11
|
Others
|
52
|
1
|
51
|
Table 2. Bacterial profile isolated from urine culture of children in both simple and complicated UTI.
The antimicrobial susceptibility pattern of each bacterial isolate are shown in Table 3. In the group of complicated UTI, Escherichia coli isolates were highly sensitive to amikacin (95.87%), ertapenem (91.74%), nitrofurantoin (92.56%), imipenem (90.08%), and cefotetan (87.60%) and high rate of resistant were also detected to ampicillin (93.39%), cephazolin (76.03%), ceftriaxone (73.55%), trimethoprim‑sulfamethoxazole (63.64%) aztreonam (64.46%). Klebsiella pneumoniae isolates showed sensitive to ertapenem (96.87%), amikacin (96.87%), imipenem (93.75%) and piperacillin-tazobactam (90.62%), while highly resistant were observed to ampicillin (96.87%), cephazolin (75.00%), ceftazidine (62.50%), ceftriaxone (62.50%), aztreonam (62.50%) and ampicillin-sulbactam (59.37%). As shown in Table 4, The isolated Gram-positive Enterococcus faecalis were sensitive to vancomycin, penicillin-G, tigecycline, linezolid and nitrofurantoin (100%, 94.83%, 88.48%, 87.93%, 86.20, respectively) and resident to tetracycline (86.21%), quinupristin (84.48%), erythromycin (75.86%). Likewise, Enterococcus faecium were sensitive to vancomycin, linezolid, tigecycline, quinupristin (98.48%, 95.45%, 84.85% , 83.33%), while resident to ampicillin (93.94%), erythromycin (89.39%), penicillin-G (84.85%), ciprofloxacin (77.27%), levofloxacin (68.18%) and tetracycline (66.67%). In the group of simple UTI, Escherichia coli were highly sensitive to ertapenem (100%), imipenem (100%), and cefotetan (100%), amikacin (95.56%) and nitrofurantoin (91.11%) and high rate of resistant were also detected to ampicillin (91.11%), trimethoprim‑sulfamethoxazole (64.44%), cephazolin (62.22%) and ceftriaxone (53.33%).
Isolates
|
Pattern
|
PG
|
Amp
|
GM
|
CP
|
LEV
|
E
|
Quinupristin
|
LZD
|
VA
|
TC
|
Tigecycline
|
FM
|
Enterococcus faecalis (N=58)
|
S
|
55 (94.83)
|
47 (81.03)
|
33 (56.90)
|
36 (62.07)
|
46 (79.31)
|
1 (1.72)
|
6 (10.35)
|
51 (87.93)
|
58 (100.00)
|
8 (13.79)
|
49 (88.48)
|
50 (86.20)
|
I
|
0 (0.00)
|
0 (0.00)
|
0 (0.00)
|
9 (15.52)
|
5 (8.62)
|
13 (22.42)
|
3 (5.17)
|
3 (5.17)
|
0 (0.00)
|
0 (0.00)
|
2 (3.45)
|
4 (6.90)
|
R
|
3 (5.17)
|
11 (18.97)
|
25 (43.10)
|
13 (22.41)
|
7 (12.07)
|
44 (75.86)
|
49 (84.48)
|
4 (6.90)
|
0 (0.00)
|
50 (86.21)
|
7 (12.07)
|
4 (6.90)
|
Enterococcus faecium (N=66)
|
S
|
8 (12.12)
|
4 (6.06)
|
27 (40.91)
|
5 (7.58)
|
8 (12.12)
|
0 (0.00)
|
55 (83.33)
|
63 (95.45)
|
65 (98.48)
|
22 (33.33)
|
56 (84.85)
|
30 (45.45)
|
I
|
2 (3.03)
|
0 (0.00)
|
0 (0.00)
|
10 (15.15)
|
13 (19.70)
|
7 (10.61)
|
5 (7.58)
|
3 (4.55)
|
1 (1.52)
|
0 (0.00)
|
3 (4.55)
|
13 (19.70)
|
R
|
56 (84.85)
|
62 (93.94)
|
39 (59.09)
|
51 (77.27)
|
45 (68.18)
|
59 (89.39)
|
6 (9.09)
|
0 (0.00)
|
0 (0.00)
|
44 (66.67)
|
7 (10.60)
|
23 (34.85)
|
CoNS (N=15)
|
S
|
0 (0.00)
|
0 (0.00)
|
6 (40.00)
|
5 (33.33)
|
6 (40.00)
|
1 (6.67)
|
11 (73.33)
|
15 (100.00)
|
15 (100.00)
|
9 (60.00)
|
7 (46.67)
|
12 (80.00)
|
I
|
1 (6.67)
|
0 (0.00)
|
0 (0.00)
|
1 (6.67)
|
2 (13.33)
|
3 (20.00)
|
1 (6.67)
|
0 (0.00)
|
0 (0.00)
|
0 (0.00)
|
1 (6.66)
|
1 (6.67)
|
R
|
14 (93.33)
|
15 (100.00)
|
9 (60.00)
|
9 (60.00)
|
7 (46.67)
|
11 (73.33)
|
3 (20.00)
|
0 (0.00)
|
0 (0.00)
|
6 (40.00)
|
7 (46.67)
|
2 (13.33)
|
Table 4. Antimicrobial susceptibility patterns of Gran-positive bacteria from simple UTI samples. PG = penicillin-G, Amp = Ampicillin; GM: Gentamycin, CP = Ciprofloxacin, LEV = Levofloxacin, E = erythromycin, LZD = Linezolid, VA = Vancomycin, TC = Tetracycline, FM = Nitrofurantoin, S, I, R = sensitive, intermediate, resistant.
Among complicated UTI patients, there were 8 children with fungal infection. Multiple drug resistances (MDR) was found in 315/389 (80.98%) of bacteria isolated (Table 5). In the group of simple UTI, MDR were also detected in 47/61 (77.05%). The detailed distribution was shown in Table 6.
Isolates
|
N
|
MDR, N(%)
|
R0
|
R1
|
R2
|
R3
|
R4
|
R5
|
R6
|
≥R7
|
Escherichia coli
|
121
|
107 (88.43)
|
4
|
4
|
6
|
9
|
7
|
6
|
12
|
73
|
Klebsiella pneumoniae
|
32
|
22 (68.75)
|
1
|
7
|
2
|
0
|
1
|
1
|
3
|
17
|
Pseudomonas aeruginosa
|
20
|
4 (20.00)
|
1
|
12
|
3
|
0
|
0
|
0
|
1
|
3
|
Enterococcus faecalis
|
58
|
47 (81.03)
|
1
|
3
|
7
|
13
|
16
|
10
|
4
|
4
|
Enterococcus faecium
|
66
|
65 (98.48)
|
0
|
0
|
1
|
1
|
8
|
9
|
12
|
35
|
Enterobacter cloacae
|
11
|
7 (63.64)
|
0
|
0
|
4
|
1
|
1
|
2
|
0
|
3
|
Citrobacter
|
13
|
8 (61.54)
|
2
|
0
|
3
|
1
|
1
|
1
|
0
|
5
|
CoNS
|
15
|
14 (93.33)
|
0
|
1
|
0
|
1
|
1
|
0
|
0
|
12
|
Proteus mirabilis
|
10
|
6 (60.00)
|
0
|
3
|
1
|
0
|
1
|
0
|
2
|
3
|
Klebsiella oxytoca
|
8
|
4 (50.00)
|
0
|
1
|
3
|
0
|
0
|
0
|
1
|
3
|
Enterobacter aerogenes
|
7
|
7 (100)
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
5
|
Others
|
28
|
24 (85.71)
|
1
|
2
|
1
|
4
|
2
|
3
|
8
|
7
|
Total
|
389
|
315 (80.98)
|
10
|
33
|
31
|
30
|
39
|
33
|
43
|
170
|
Table 5. Multi drug resistance pattern of bacterial isolates from children with complicated UTI. MDR = multiple drug resistance, R1 = resistance to one drugs, R2 = resistance to two drugs, R3 = resistance to three drugs, R4 = resistance to four drugs, R5 = resistance to five drugs, R6 = resistance to six drugs, R7 = resistance to seven drugs.
Isolates
|
N
|
MDR, N(%)
|
R0
|
R1
|
R2
|
R3
|
R4
|
R5
|
R6
|
≥R7
|
Escherichia coli
|
45
|
35 (77.78)
|
2
|
1
|
7
|
4
|
1
|
7
|
8
|
15
|
Klebsiella pneumoniae
|
1
|
0 (0.00)
|
1
|
|
|
|
|
|
|
|
Citrobacter (枸橼酸杆菌)
|
1
|
0 (0.00)
|
|
|
1
|
|
|
|
|
|
Proteus mirabilis
|
2
|
2 (100)
|
|
|
|
|
1
|
|
|
1
|
Enterococcus faecalis
|
1
|
1 (100)
|
|
|
|
|
|
1
|
|
|
Enterococcus faecium
|
4
|
3 (75.00)
|
|
1
|
|
|
|
1
|
|
2
|
Enterobacter cloacae
|
2
|
1 (50.00)
|
|
|
1
|
|
|
|
1
|
|
CoNS
|
4
|
4 (100)
|
|
|
|
|
1
|
|
|
3
|
Enterobacter aerogenes
|
1
|
1 (100)
|
|
|
|
1
|
|
|
|
|
Total
|
61
|
47 (77.05)
|
|
|
|
|
|
|
|
|
Table 6. Multi drug resistance pattern of bacterial isolates from children with simple UTI. MDR = multiple drug resistance, R1 = resistance to one drugs, R2 = resistance to two drugs, R3 = resistance to three drugs, R4 = resistance to four drugs, R5 = resistance to five drugs, R6 = resistance to six drugs, R7 = resistance to seven drugs.