Community-acquired Pseudomonas aeruginosa urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and treatment.

BACKGROUND: The practice of antibiotic prophylaxis against recurrent urinary tract infection (UTI), with hospitalization reserved for severe or complicated cases, has led to changes in the nature and culprit uropathogens of community-acquired (CA), hospital-treated UTI. Characterization of subgroups that need special considerations is crucial.

OBJECTIVES: To elucidate the trends and characteristics of CA Pseudomonas UTI in hospitalized children; define the antibiotic susceptibility; determine the appropriateness of the empiric antibiotics used; compare to other causes of UTI in this population; and thereby define predictors for Pseudomonas UTI.

METHODS: A prospective clinical and laboratory study from 2001 through 2005. Children with P. aeruginosa UTI were characterized and compared with non-Pseudomonas UTI.

RESULTS: Of 351 episodes of culture-proven CA UTI, 28 (8%) were caused by Pseudomonas, representing a 2.8-fold increase from our previous study. Pseudomonas UTI was more common in children > 5 years (p < 0.01), with urinary abnormalities (p < 0.01) and with previous antibiotic use in the previous month (p < 0.001). Pseudomonas UTI was often resistant to antibiotics usually recommended for empiric therapy; 25% was initially treated with inappropriate IV antibiotics (4.6% in the non-Pseudomonas group, p < 0.001) with 1.3 days longer IV antibiotics. On multivariate analysis, risk factors for Pseudomonas UTI were previous antibiotic therapy and underlying urinary pathology.

CONCLUSIONS: Pseudomonas UTI seems to increase in CA, hospital-treated children and is often treated inappropriately according to current treatment protocols. Awareness of this trend and knowledge of the defined risk factors of Pseudomonas UTI might improve the empiric antibiotic therapy.