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Original Research

Program: Section on Urology

O3334: Evaluating the prevalence, risk factors, and resistance patterns of non-E. coli urinary tract infections in children: who is at risk and why should we care?

Sunday, September 28, 2025
9:36 AM - 9:43 AM MDT
Location: Colorado Convention Center, Mile High Ballroom 3C
Oral Presentation
Background: Non-E.coli urinary tract infections (UTI) have been associated with genitourinary abnormalities and it has been recommended that non-E.coli UTIs undergo imaging and work-up to assess for urologic abnormalities. However, little is known about how Non-E.coli UTI differ from E.coli UTI in degree of antibiotic resistance. Herein, we compare the prevalence, risk factors, and resistance patterns between E.coli and non-E.coli UTIs in children.

Methods: An institutional database of culture-proven UTIs between 2022 and 2024 in children( < 18 years) was evaluated. Clinical characteristics were compared between cultures with non-E.coli UTI and E.coli UTI. Resistance patterns to five oral antibiotics were captured (penicillin-class, cephalosporin-class, nitrofurantoin, sulfa-based, fluoroquinolones). Risk factors were identified on a multivariate analysis.

Results: A total of 674 infections were noted among 308 unique patients (81% female, median age 9 years old, 18% CAKUT). Predictors of non-E.coli infections on multivariate analysis included male sex (OR 2.2), congenital abnormalities of kidney and urinary tract (CAKUT; OR 2.0), spinal abnormalities (including myelomeningocele; OR 9.1), non-febrile presentation (OR 1.3), and active antibiotic treatment or prophylaxis (OR 1.8).There was a higher degree of antibiotic resistance to ≥3 oral antibiotics for those with E.coli infections (29% vs. 17%, p< 0.0001). Non-E.coli cultures were more likely to harbor resistance for nitrofurantoin, amoxicillin, and cephalexin but less likely to harbor resistance to, amoxicillin-clavulanate, TMP-SMX, and ciprofloxacin.

Conclusion: Children with urologic disorders and antibiotic prophylaxis are at risk of non-E.coli UTIs, which appear to have different resistance patterns to E.coli UTIs. This should be considered in clinical practice in prescribing empiric antibiotic therapy for UTI.