Multidrug-resistant uropathogens in pediatric urinary tract infections: a multicenter retrospective trend analysis (2020–2024)

Large-scale public health disruptions, including pandemics and natural disasters, may influence healthcare delivery, pathogen distribution, and antimicrobial resistance (AMR). This retrospective multicenter study evaluated uropathogen profiles and temporal trends in antibacterial resistance among hospitalized pediatric patients with urinary tract infections (UTIs) across periods corresponding to the COVID-19 pandemic, the February 6, 2023 Kahramanmaraş earthquakes, and the post-earthquake phase in heavily affected regions of Türkiye. Hospitalized pediatric patients (0-18 years) with culture-confirmed UTIs admitted between January 2020 and December 2024 to three tertiary care hospitals were included. Pathogen identification and antibacterial susceptibility testing were performed using standard microbiological methods in accordance with EUCAST criteria. Uropathogen distribution and resistance patterns were compared across predefined study periods. A total of 1131 pediatric patients were analyzed, of whom 54.29% were female. Gram-negative bacteria predominated (89.57%), with Escherichia coli (59.86%) and Klebsiella spp. (18.92%) being the most frequently isolated pathogens. Across the study periods, E. coli demonstrated significant increases in resistance to ampicillin (63.26% to 81.90%), ceftriaxone (41.99% to 53.76%), ceftazidime (39.46% to 63.10%), and trimethoprim-sulfamethoxazole (32.27% to 40.34%) (all p < 0.01). Among Klebsiella spp., a significant temporal increase was observed only for imipenem resistance, which rose from 18.64% during the COVID-19 period to 37.50% during the earthquake period before declining to 13.21% in the post-earthquake period (p = 0.021). Multidrug-resistant (MDR) phenotypes were predominantly detected among Gram-negative organisms, with the highest proportions observed in Serratia spp., Citrobacter spp., Enterobacter spp., and Pseudomonas spp., while MDR prevalence in E. coli was comparatively lower. Temporal variations in antibacterial resistance were observed among pediatric UTI pathogens during periods of major public health disruption. These findings highlight the importance of sustained regional surveillance and context-aware empiric treatment strategies in settings exposed to systemic healthcare stressors.