Bacteria aetiologies and antibiotic resistance profiles in pediatric urinary tract infections associated with congenital abnormalities of the kidney and urinary tract at Entebbe Children's Surgical Hospital

Abstract

Background: Urinary Tract Infections (UTIs) are among the most common bacterial infections in childhood. Malformation of the urinary tract often leads to recurrent infections. The increased risk of UTIs in children with these malformations often leads to a higher need for antibiotic treatment which can result in antimicrobial resistance. This study aimed to investigate the bacterial etiologies and antibiotic resistance profiles in urinary tract infections among pediatric patients with anatomical urological abnormalities at the Children's Surgical Hospital Entebbe (CSHE). Methods: A quantitative cross-sectional study was, conducted at the CSHE, from January 2024 to May 2025. Pediatric patients below 18 years with CAKUT except bladder exstrophy and urine analysis suggestive of UTI were sampled purposively. A structured questionnaire was used to collect data and midstream urine, neonatal bagged urine, in and out foley, or suprapubic urine was collected aseptically for urinalysis and isolated organisms antibiotic resistance profiles tested. Descriptive statistics and logistic regression in Stata 18 were used to analyze the data. Results: Of 101 participants 35.6% were aged 1-3 years and 90.1% male. The prevalence of UTI was 18.8%. Bacteria isolates were predominantly gram-negative with Escherichia coli (42.1%) and Pseudomonas aeruginosa (26.3%) being the commonly isolated bacteria. E.coli had high sensitivity to amikacin, gentamicin, meropenem, and chloramphenicol (100%), but exhibited complete resistance to amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. P.aeruginosa was completely sensitive to ciprofloxacin (100%) but had decreased sensitivity (60%) for amikacin, gentamicin, and meropenem. Enterococcus faecium was completely resistant to ampicillin, ciprofloxacin, and gentamicin synergy but sensitive to vancomycin. Male sex (AOR = 0.03; 95% CI = 0.00–0.52, p = 0.017) and recent hospitalization (AOR = 12.43; 95% CI = 1.08–141.88, p = 0.042) were statistically significant independent predictors of UTI. Conclusion: UTIs among children with CAKUT were primarily caused by drug-resistant Gram-negative organisms. Male sex was protective against UTI, while recent hospitalization significantly increased UTI risk. The findings emphasize the importance of routine culture and sensitivity testing to guide appropriate antibiotic use.