ArticleClinical and experimental pediatrics2026
Discordance between antibiotic therapy and recurrent urinary tract infections in young children with third-generation cephalosporin-resistant infections.
Article in Clinical and experimental pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThird-generation cephalosporins remain the empirical mainstay for pediatric urinary tract infections (UTIs) in Korea, yet the resistance rate now approaches 30%, thereby threatening treatment effectiveness. PURPOSE: To determine whether completing a cephalosporin regimen, despite in vitro resistance, increases early UTI recurrence rates.
methodsWe retrospectively reviewed the cases of children aged <24 months with their first Gram-negative UTI admitted in 2020-2024. Three exposure groups were defined: susceptible isolates treated with a third-generation cephalosporin; resistant isolates that received ≥5 days of antibiotics to which the isolated organism was susceptible (concordant); and resistant isolates that received <5 days of appropriate antibiotic therapy (discordant). The primary outcome was UTI recurrence within 2 months. Kaplan- Meier curves were generated, while multivariate Cox models adjusted for age, fever, acute cortical defects, and kidney anomalies were used to estimate hazard ratios (HRs).
resultsAmong 989 children (mean age, 4.4 months), 424 (42.9%) had cefotaxime-resistant isolates; of them, 76 (17.9%) received concordant therapy and 348 (82.1%) received discordant therapy. The overall 2-month recurrence rate was 15.4% (95% confidence interval [CI], 13.0-17.7). Compared to the susceptible group, the concordant group did not show a significantly different relapse rate (adjusted HR [aHR], 1.09; 95% CI, 0.67-1.78), whereas the discordant group demonstrated an increased recurrence risk (aHR, 1.42; 95% CI, 1.08-1.86). An analysis of culture-confirmed recurrence yielded similar findings (discordant therapy aHR, 1.82; 95% CI, 1.29-2.56). No significant differences were observed when the analysis was restricted to febrile recurrence.
conclusionCompleting a third-generation cephalosporin course when isolates are not susceptible to thirdgeneration cephalosporins can increase early UTI recurrence rates in Korean children. Reviewing susceptibility on day 5 and switching to an active oral agent may reduce recurrence and limit unnecessary broad-spectrum antibiotic exposure.
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