Prevalence and Factors of Community-Acquired Urinary Tract Infections in Children Caused by Drug-Resistant Microorganisms at Nakhon Pathom Hospital

Background: Urinary tract infections (UTIs) are a common pediatric condition and a growing concern due to increasing antimicrobial resistance. Identifying risk factors for drug-resistant pathogens and evaluating empirical antibiotic susceptibility are essential for improving treatment outcomes. Objectives: The study aimed to determine the prevalence of drug-resistant microorganisms causing community-acquired UTIs in children, identify associated risk factors, and assess the susceptibility of empirical antibiotics recommended by Thai national guidelines. Methods: This retrospective study included children aged 0–15 years with community-acquired UTIs from January 2021 to February 2025. Demographic and clinical data were collected. Categorical variables were summarized as frequencies and percentages. Multivariable logistic regression analysis was performed to identify independent risk factors. Results: Among 165 patients, Escherichia coli was the most common pathogen (66.7%). Drug-resistant microorganisms were identified in 124 cases (75.2%). Among Enterobacteriaceae isolates, 37% were extended-spectrum β-lactamase producers and 40.9% were multidrug-resistant. Younger age (OR 0.99; 95% CI 0.99–0.99) and a history of recurrent UTIs (OR 6.88; 95% CI 1.57–30.22) were independent risk factors for drug-resistant infections. Male sex and a history of antibiotic treatment within the preceding 30 days were associated with resistance to ceftriaxone and cefotaxime. Amikacin showed the highest susceptibility rate (92.1%), while amoxicillin-clavulanate had the highest susceptibility among oral agents (67.3%). Conclusions: Drug-resistant microorganisms are highly prevalent in pediatric community-acquired UTIs. Younger age and recurrent UTIs are key risk factors, while male sex and recent antibiotic treatment are associated with resistance to commonly used third-generation cephalosporins. Amikacin demonstrated the highest susceptibility rate among the empirical antibiotic options.