Antibiotic resistance of Escherichia coli in urinary tract infections in pediatric patients: a literature review

Abstract

Antimicrobial resistance represents one of the most serious global public health threats, and in pediatric care, it poses a growing challenge in the treatment of urinary tract infections (UTIs), where Escherichia coli is the most frequently identified pathogen. This literature review aimed to analyze recent scientific evidence on the antibiotic resistance patterns of E. coli in pediatric UTIs, in order to identify trends that may guide clinical practice and prevention strategies. A structured bibliographic search was conducted in three databases—PubMed, SciELO, and Google Scholar—covering the period between 2019 and 2024. A total of 23 studies were selected, including original articles and narrative reviews, that met the following inclusion criteria: population under 18 years of age, microbiologically confirmed diagnosis, and full-text availability. The reviewed literature revealed a high prevalence of resistance to commonly used antibiotics in clinical practice, such as ampicillin and trimethoprim-sulfamethoxazole, with significant geographic variation. In contrast, carbapenems such as meropenem and imipenem exhibited low resistance rates, positioning them as effective therapeutic options for complicated clinical cases. Moreover, multidrug-resistant strains were reported in several countries, increasing the complexity of empirical treatment approaches. These findings underscore the urgent need to strengthen microbiological surveillance systems, regularly update pediatric clinical guidelines, and promote the rational use of antimicrobials. The review also highlights the importance of generating local evidence in Latin America, given the limited number of regional studies, to better inform empirical therapy and improve clinical outcomes in pediatric populations affected by urinary tract infections caused by antibiotic-resistant Escherichia coli.