Non-Escherichia coli versus Escherichia coli community-acquired urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and outcome

Pediatr Infect Dis J. 2005 Jul;24(7):581-5. doi: 10.1097/01.inf.0000168743.57286.13.


Background: Currently hospitalization for children with urinary tract infections (UTIs) is reserved for severe or complicated cases. Changes may have taken place in the characteristics and causative uropathogens of hospital-treated community-acquired UTI.

Objectives: To study children hospitalized in a tertiary center with community-acquired UTI, compare Escherichia coli and non-E. coli UTI, define predictors for non-E. coli UTI and elucidate the appropriate therapeutic approach.

Patients and methods: A prospective clinical and laboratory study from 2001 through 2002 in a tertiary pediatric medical center. Patients were divided by results of the urine culture into E. coli and non-E. coli UTI groups, which were compared.

Results: Of 175 episodes of culture-proved UTI, 70 (40%) were caused by non-E. coli pathogens. Non-E. coli UTI was more commonly found in children who were male (P = 0.005), who had underlying renal abnormalities (P = 0.0085) and who had received antibiotic therapy in the prior month (P = 0.0009). Non-E. coli uropathogens were often resistant to antibiotics usually recommended for initial therapy for UTI, including cephalosporins and aminoglycosides; 19% were initially treated with inappropriate empiric intravenous antibiotics (compared with 2% for E. coli UTI, P = 0.0001), with a longer hospitalization.

Conclusions: Current treatment routines are often inappropriate for hospitalized children with non-E. coli UTI, which is relatively common in this population. The defined risk factors associated with non-E. coli UTIs and its antimicrobial resistance patterns should be considered to improve empiric antibiotic therapy for these infections.

Publication types

  • Comparative Study

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Child, Preschool
  • Community-Acquired Infections / epidemiology*
  • Community-Acquired Infections / microbiology*
  • Drug Resistance, Bacterial
  • Escherichia coli / drug effects
  • Escherichia coli Infections / epidemiology*
  • Escherichia coli Infections / microbiology
  • Female
  • Hospitalization*
  • Humans
  • Infant
  • Male
  • Microbial Sensitivity Tests
  • Prospective Studies
  • Risk Factors
  • Treatment Outcome
  • Urinary Tract Infections / epidemiology*
  • Urinary Tract Infections / microbiology*
  • Urine / microbiology


  • Anti-Bacterial Agents