Search Results (922)

Background/Objectives: Urinary tract infections (UTIs) are common infectious complications in kidney transplant recipients (KTRs) and non-transplant nephrology patients. However, direct culture-based comparisons of urinary isolate distribution and antimicrobial resistance profiles between KTRs and non-transplant nephrology (NTN) patients remain limited. This study compared urinary isolates recovered from urine cultures with significant growth and their in vitro antimicrobial resistance profiles in hospitalized KTRs and NTN patients. Methods: In this retrospective culture-based study, urine culture results from patients hospitalized in the nephrology and kidney transplantation units between 1 January 2024 and 31 December 2025 were reviewed. Urinary isolate distribution, in vitro antimicrobial resistance profiles, and extended-spectrum β-lactamase (ESBL) production were compared between the two. Results: A total of 397 patients with at least one urine culture showing significant growth were included, comprising 220 KTRs and 177 NTN patients. Enterobacterales were significantly more frequent among KTRs than among NTN patients (77.2% vs. 41.1%, p < 0.001). Escherichia coli was the predominant urinary isolate in both groups. In contrast, Candida spp. (26.8% vs. 3.2%, p < 0.001), Enterococcus spp. (15.8% vs. 7.7%, p < 0.001), and non-fermenting Gram-negative bacteria (9.4% vs. 3.4%, p = 0.001) were more frequently recovered from NTN patients. Among E. coli isolates, resistance to gentamicin (p = 0.006) and ertapenem (p = 0.001) was significantly higher in the NTN group. Likewise, Klebsiella pneumoniae isolates from NTN patients showed significantly higher resistance to third-generation cephalosporins, aminoglycosides, and carbapenems (p < 0.05). ESBL production was also more frequent in NTN patients than in KTRs (55.7% vs. 41.9%, p = 0.013). Conclusions: Hospitalized KTRs and NTN patients exhibited distinct urinary isolate distributions and in vitro antimicrobial resistance profiles. These findings should be interpreted as culture-based epidemiological data rather than as differences in clinically confirmed UTI burden. Stratified local surveillance may help contextualize urinary isolate and susceptibility patterns across hospitalized nephrology populations. Full article

Background/Objectives: Antimicrobial resistance in pediatric urinary tract infections (UTIs) is a growing concern. We evaluated resistance patterns of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa urinary isolates in a tertiary care Greek hospital from 2015 through 12 September 2025. Methods: We retrospectively analyzed pediatric urinary isolates collected from 2015 through September 2025. Antibiotic analysis was restricted to EUCAST UTI-relevant organism-drug pairs. Resistance was summarized for the prespecified antibiotics, and presumptive ESBL and carbapenem resistance phenotypes were assessed. Results: Among 776 isolates (567 E. coli, 104 K. pneumoniae, 105 P. aeruginosa), E. coli showed the lowest resistance among non-carbapenem options to nitrofurantoin (0.4%), amikacin (1.2%), and gentamicin (7.8%), and the highest to trimethoprim (98.8%), ampicillin (53.5%), and trimethoprim-sulfamethoxazole (31.5%). K. pneumoniae had the lowest resistance among non-carbapenem options to amikacin (8.6%) and gentamicin (15.5%), with high cephalosporin resistance (oral cefuroxime 40.9%, intravenous cefuroxime 39.7%). Presumptive ESBL and carbapenem resistance in K. pneumoniae were 42.3% and 20.2%, respectively. Corresponding prevalences in E. coli were 12.4% and 0.7%. P. aeruginosa retained low resistance to meropenem (1.9%) and piperacillin-tazobactam (2.1%). No age or sex association with the presumptive resistance phenotypes remained significant after false-discovery-rate adjustment. Conclusions: E. coli showed very high ampicillin resistance, low resistance to gentamicin and amikacin, and moderate resistance to guideline-relevant cephalosporins. P. aeruginosa retained low resistance to key antipseudomonal agents. K. pneumoniae showed the highest burden of cephalosporin resistance and of presumptive ESBL and carbapenem resistance phenotypes. These data support guideline-based empirical coverage more strongly for E. coli than for K. pneumoniae in this setting. Full article

Recurrent urinary tract infection (rUTI) continues to pose a formidable clinical challenge, largely owing to the rapid clearance of therapeutic agents from the bladder caused by short intravesical residence time and periodic urinary voiding. Although intravesical drug delivery has emerged as a promising local therapeutic strategy, conventional liquid instillations and physically crosslinked hydrogels frequently fail to sustain structural integrity and prolonged drug release within the dynamically changing bladder microenvironment. Herein, we develop a photocrosslinkable, pH-responsive intravesical floating drug delivery system (iFDDS) for sustained antimicrobial delivery. This system is fabricated using diacrylated Pluronic F127 (F127DA) as the core network-building component. The covalently crosslinked F127DA network confers superior mechanical stability while preserving amphiphilic micellar domains that enable efficient loading of hydrophobic drugs. A tertiary amine-based pH-responsive crosslinker (CLMA) is further integrated into the hydrogel matrix, endowing iFDDS with enhanced swelling capacity under the mildly acidic microenvironment. Additionally, lyophilization-induced porous architecture reduces the apparent density of the iFDDS below that of urine, achieving stable flotation for over 48 h and effectively mitigating the risk of urinary tract obstruction. The optimized iFDDS exhibits favorable catheter deliverability, shear-thinning rheological behavior adaptable to dynamic fluid conditions, and excellent biocompatibility with bladder epithelial cells. Upon loading with rifampicin, the iFDDS demonstrates potent and sustained antibacterial efficacy against Escherichia coli. This study establishes a robust, environment-adaptive platform for intravesical therapy, offering a viable strategy to address the short residence time limitation of conventional formulations and improve the therapeutic management of rUTI. Full article

Background: People living with dementia (PLWD) are at increased risk for medical complications, including urinary tract infections (UTIs), which are often presented atypically with delirium or behavioral changes. These atypical presentations frequently prompt psychiatric consultation and complicated medical management. As the aging population grows, understanding how dementia influences UTI-related outcomes is critical for C-L psychiatrists working at the interface of medicine and psychiatry. Methods: This retrospective cohort study used the 2021 National Inpatient Sample (NIS) to identify adult inpatients with a principal diagnosis of UTI. Patients were stratified by the presence of a comorbid dementia diagnosis. Multivariate logistic and linear regression models adjusted for demographic, clinical, and hospital-level covariates were used to examine associations between dementia and outcomes: in-hospital mortality (primary), length of stay (LOS), hospital charges, and discharge disposition (secondary). Adjusted models included available demographic, socioeconomic, comorbidity, and hospital-level covariates, including age, sex, race/ethnicity, median household income quartile by patient ZIP code, insurance type, Charlson Comorbidity Index, hospital region, urban hospital location, and hospital teaching status. Results: Among 295,494 hospitalizations for UTI, 78,990 (26.7%) involved patients with dementia. Compared to those without dementia, PLWD were significantly older (mean age 82.5 vs. 69.5 years), more likely to be female, and had greater comorbidity burden. Adjusted analyses revealed that dementia was linked to higher odds of in-hospital mortality (aOR: 1.28, 95% CI: 1.03–1.58), longer LOS (+0.93 days, p < 0.01), and increased hospital charges (+$3243.50, p < 0.01). Additionally, PLWD had lower odds of discharge to home (aOR: 0.53) and higher odds of discharge to skilled nursing facilities (aOR: 1.94). Conclusions: Among patients hospitalized with a principal diagnosis of UTI, comorbid dementia was linked with higher in-hospital mortality, longer length of stay, higher hospital charges, and lower likelihood of discharge home. These findings should be interpreted in the context of important limitations of administrative data, including residual confounding and inability to distinguish symptomatic UTI from asymptomatic bacteriuria. Full article

Urinary tract infections are among the most common bacterial infections encountered in clinical practice, with Escherichia coli representing the dominant urinary pathogen. Increasing detection of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing uropathogens has narrowed empirical treatment options and renewed interest in fosfomycin. However, local long-term surveillance data on fosfomycin susceptibility remain limited in Pakistan. This study evaluated temporal changes in major urinary isolate categories and fosfomycin susceptibility patterns within a diagnostic laboratory network in Pakistan from 2013 to 2025. An exploratory molecular sub-analysis was also performed to assess selected resistance-associated transcript patterns in archived fosfomycin-susceptible and fosfomycin-resistant isolates. A retrospective laboratory-based, isolate-level analysis was conducted using anonymized urine culture records. The source database included 34,230 urine sample records, from which eligible culture-positive urinary isolates with required organism classification and fosfomycin susceptibility data were included in the final analytical dataset. Analyses were performed across predefined mutually exclusive study intervals. Organism categories included non-ESBL E. coli, ESBL-producing E. coli, laboratory-coded ESBL E. coli 24 variant, Klebsiella spp., and Enterococcus spp. The ESBL E. coli 24 variant was treated as a laboratory reporting category, not as a genomically confirmed clone or sequence type. Fosfomycin resistance was evaluated using interval-based comparisons and odds ratios. A selected subset of 24 archived isolates, including fosfomycin-susceptible and fosfomycin-resistant E. coli and Klebsiella pneumoniae, was analyzed by RT-qPCR for glpT, uhpT, murA, fosA, fosA3, and blaCTX-M transcript abundance. The final isolate-level analytical dataset included 17,978 eligible urinary isolates. Among urine records with available sex data, female-associated records represented the majority throughout the study period, but this finding reflects laboratory record distribution rather than patient-level UTI prevalence. E. coli remained the predominant urinary isolate category. Non-ESBL E. coli declined across study intervals, whereas ESBL-associated E. coli categories represented a larger proportion of isolates in later years. The laboratory-coded ESBL E. coli 24 variant increased in later intervals, although this finding requires cautious interpretation because confirmatory molecular typing was not performed. Fosfomycin resistance showed a non-linear temporal pattern: resistance decreased from the early to the middle interval and then increased markedly to 23.8% during 2021–2025, while susceptibility declined to 60.6% in the same interval. Compared with the middle interval, isolates from 2021–2025 had higher odds of fosfomycin resistance (OR = 3.64, 95% CI: 3.23–4.12; p < 0.001). In the exploratory molecular subset, resistant isolates showed lower transcript abundance of selected uptake-associated genes, particularly glpT and uhpT, and higher expression of selected fosfomycin- and ESBL-associated genes, including fosA, fosA3, and blaCTX-M. These findings represent transcriptional associations in selected isolates and do not establish definitive resistance mechanisms. Urinary isolates in this diagnostic-network dataset showed a temporal shift toward greater representation of laboratory-reported ESBL-associated E. coli categories and a marked increase in fosfomycin resistance during 2021–2025. The findings support continued local surveillance of urinary pathogens and periodic reassessment of fosfomycin susceptibility for antimicrobial-stewardship guidance. The molecular findings should be interpreted as exploratory transcriptional observations because they were based on a small selected isolate subset and were not supported by genomic, mutational, uptake, or functional validation. Full article

After radical hysterectomy for cervical cancer, postoperative bladder dysfunction is common. This randomized controlled trial evaluated whether adjunctive transcutaneous electrical acupoint stimulation (TEAS) reduces urinary retention. A total of 108 patients were assigned to a control group (standard bladder training, n = 53) or a TEAS group (standard training plus daily 30 min TEAS for 7 days from postoperative day 3, n = 55). The primary outcome was urinary retention (post-void residual > 100 mL on day 11). Secondary outcomes included residual volume, recovery time, recatheterization, urinary tract infection (UTI), treatment efficacy, and quality of life (SF-36). Urinary retention occurred in 35.8% of controls versus 23.6% of TEAS patients (p = 0.164). TEAS significantly reduced median residual volume (70 vs. 85 mL, p = 0.004), shortened median recovery time (2 vs. 4 h, p < 0.001), and lowered recatheterization (16.4% vs. 34.0%, p = 0.036). UTI rates were similar. Treatment efficacy favored TEAS (p = 0.009), and all eight SF-36 domains significantly improved (all p < 0.01). In conclusion, adjunctive TEAS did not significantly reduce the primary outcome of urinary retention but significantly improved multiple secondary bladder-emptying measures and quality of life after radical hysterectomy for cervical cancer. Full article

Urinary tract infections (UTIs) are a significant global health concern, with women being disproportionately affected. As the clinical importance of Klebsiella spp. as uropathogens continues to rise, this study aimed to determine their prevalence and associated factors among women attending a tertiary hospital in Libreville, Gabon. Bacteriological urine analyses were conducted on 791 women (inpatients and outpatients) at the Omar Bongo Ondimba Army Instruction Hospital between April and December 2024. Bacterial identification was performed using Analytical Profile Index (API 20E) strips and the VITEK^® 2 Compact system. The overall UTI prevalence was 43.6% (345/791). Klebsiella spp. accounted for 14.4% (114/791) of all cases, representing an isolation rate of 33.0% (114/345) among infected participants. Klebsiella pneumoniae species complex (KpSC) was the predominant species (84.2%), followed by K. aerogenes (9.6%) and K. oxytoca (6.1%). Marital status was significantly associated with Klebsiella spp. UTIs; compared to single/divorced women, widows (OR = 2.1; 95% CI: 1.0–4.5) and those in married or cohabiting unions (OR = 1.7; 95% CI: 1.1–2.6) exhibited a significantly higher risk of infection. These findings highlight a substantial proportion of UTIs caused by Klebsiella spp. in Libreville and underscore the influence of sociodemographic factors on infection risk, emphasizing the need for targeted preventive measures in at-risk populations. Full article

Urinary tract infections (UTIs) are considered a significant public health issue due to their high incidence and prevalence, most notably among women. The potential for complications, including recurrent infections and antibiotic resistance, negatively impacts patient quality of life and correspondingly results in elevated healthcare costs. Efficacy of antibiotic pharmacotherapy has been shown to be limited in the treatment of UTIs. The use of antibiotics has been further exacerbated by the unprecedented spread of antimicrobial-resistant organisms. This paper reviews the microbiome specific to UTIs and the formation of biofilms in UTI patients, and presents the current status of novel biological and chemical approaches designed to inhibit and eradicate biofilms in UTI patients. Full article

Urinary tract infections (UTIs) sit at a leading edge of the antimicrobial-resistance (AMR) crisis, and Romania ranks among the most affected European countries, yet large single-center series of urinary isolates with complete antibiograms remain scarce. We describe the full resistance landscape of urinary pathogens at a Romanian tertiary hospital, with particular attention to multidrug-resistant Klebsiella and to the often-overlooked urease-positive organisms. We analyzed all positive urine cultures processed over 13 consecutive months (February 2025–February 2026). The first isolate per patient was the primary unit of analysis (n = 2331); the full isolate-level dataset (n = 3348) was analyzed secondarily. Resistance phenotypes (putative ESBL, carbapenem resistance, MDR, VRE) were derived from per-agent susceptibility data following Magiorakos et al., and resistance rates were calculated only on tested isolates. Associations were tested with chi-square/Fisher tests and Benjamini–Hochberg correction. A total of 3348 isolates from 2331 unique patients were analyzed (median age 68 years; 55% male). Escherichia coli predominated (40.5%), followed by Enterococcus spp. (22.2%) and Klebsiella spp. (18.9%). Among the first isolates, 15.3% were MDR; 16.7% of E. coli, Klebsiella and Proteus showed a putative ESBL phenotype; and 3.9% of Enterobacterales were carbapenem-resistant. Resistance was concentrated in Klebsiella (36.2% MDR, 22.8% putative ESBL, 14.7% carbapenem-resistant; all higher than E. coli, p < 0.001) and in Pseudomonas spp. (48.1% carbapenem-resistant). E. coli retained excellent activity to nitrofurantoin (1.2%), fosfomycin (1.2%; tested in a subset) and ertapenem (0.1%) despite high trimethoprim–sulfamethoxazole (31.5%) and fluoroquinolone (24.3%) resistance. Urease-positive organisms formed a distinct subgroup with high trimethoprim–sulfamethoxazole resistance but preserved carbapenem activity. The urinary resistance burden was substantial but uneven, concentrated in Klebsiella and Pseudomonas. These findings support a stratified, locally guided empirical strategy and combined stewardship–infection control efforts. Full article

Urogenital toileting practices for residents in nursing homes (NHs) and their implications for the occurrence of bacteriuria remain largely unknown. Our purpose was to assess urogenital toileting practices in NHs in our region and their association with bacteriuria and urinary culture contamination rates. NHs reported on the direction of urogenital cleaning with respect to the urinary meatus and related practices during resident care over 7 years (2017 to 2023). Linear mixed models were used to relate two urogenital cleaning techniques, with bacteriuria rates (positive urinary cultures per resident over a year) and urinary culture contamination proportions. Of the 111 participating NHs, 33% used a technique involving outward cleaning with respect to the urinary meatus. Of these, 50 institutions had 7-year urinary microbiological data available (10,602 cultures, 13,059 isolates). Escherichia coli (45%) was the most frequently isolated microorganism while 12.4% of all cultures were contaminated (>3 microorganisms). We did not observe any significant association between the cleaning technique and the bacteriuria rates. The technique involving outward cleaning away from the urinary meatus was associated with lower odds of urinary culture contamination (odds ratio = 0.15, 95% CI: 0.05–0.48, p < 0.01). Urogenital cleaning techniques varied across participating institutions. We observed an association with urinary culture contamination, but not with bacteriuria rates. These findings warrant further investigation. Full article

Background/Objectives: The clinical utility of renal ultrasound after pediatric urinary tract infection (UTI) remains controversial, particularly because not all ultrasonographic abnormalities have the same prognostic significance. This study aimed to determine whether nephrourological malformations identify the phenotype associated with greater subsequent clinical burden among children hospitalized with presumed UTI and interpretable renal ultrasound findings, and to differentiate this phenotype from non-malformative ultrasound abnormalities. Methods: A retrospective single-center hospital-based cohort study was conducted in children aged 2 months to 17 years hospitalized with a clinical diagnosis of UTI at a general hospital of the Mexican Social Security Institute between 2020 and 2025. The cohort included both microbiologically confirmed UTI cases and probable clinical/microbiologically unconfirmed UTI cases. Of 182 registered patients, 130 with interpretable renal ultrasound were included. The primary exposure was the presence of adjudicated nephrourological malformation. As a secondary exposure, within the subgroup without malformation, abnormal non-malformative ultrasound findings were compared with normal ultrasound findings. Outcomes included outpatient follow-up, subspecialty referral, and hospital readmission. Crude associations were expressed as relative risks (RR), and adjusted analyses were estimated using modified Poisson regression with HC3 robust errors. Results: Twenty-nine of 130 patients (22.31%) were classified as having nephrourological malformations, and 31 (23.85%) had abnormal non-malformative ultrasound findings. Malformations were associated with higher outpatient follow-up (79.31% vs. 44.55%; RR 1.78, 95% CI 1.34–2.37), greater subspecialty referral (79.31% vs. 49.50%; RR 1.60, 95% CI 1.22–2.10), and increased readmission (44.83% vs. 13.86%; RR 3.23, 95% CI 1.72–6.08). In adjusted models, malformations remained associated with follow-up (aRR 1.72, 95% CI 1.25–2.37), referral (aRR 1.59, 95% CI 1.17–2.16), and readmission (aRR 3.38, 95% CI 1.58–7.23). In contrast, abnormal non-malformative ultrasound findings showed no significant adjusted associations. Microbiologically confirmed UTI was present in 47/130 patients (36.15%), and malformations were more frequent in this subgroup than in probable/non-confirmed clinical UTI (34.04% vs. 15.66%; p = 0.027). Conclusions: In this single-center hospital-based cohort, subsequent clinical burden was concentrated in the nephrourological malformation phenotype rather than in the broader category of “abnormal ultrasound”. These findings suggest that renal ultrasound may serve as a useful prognostic stratification tool beyond its role as a nonspecific detector of abnormalities following pediatric UTI. Given the observational design, these associations should be confirmed in larger prospective studies. Full article

Background: Catheter-associated urinary tract infections (CAUTIs) are a major concern in patients with long-term indwelling urinary catheters, especially those with neurogenic bladder. This study assessed whether proactive cystoscopic removal of bladder debris reduces symptomatic UTI incidence and catheter blockage. Methods: This prospective, self-selected cohort study was conducted between January 2022 and December 2025 at a tertiary center in Taiwan. Enrollment occurred from January 2022 to June 2024, with follow-up completed by December 2025. Patients chose standard CDC-guided care (control, n = 63) or standard care plus flexible cystoscopy every 3 months for gentle low-volume evacuation (<100 mL normal saline) of dependent bladder debris (intervention, n = 141). Inverse probability of treatment weighting (IPTW) was used to address selection bias. Symptomatic UTIs were prospectively recorded using strict criteria. Cumulative incidence was analyzed with Kaplan–Meier methods and multivariable Cox regression. Results: After IPTW, baseline characteristics were well balanced. Median follow-up was 26 months (IQR 18–34). The incidence of catheter blockage was significantly lower in the intervention group (7.8% vs. 22.2%, p = 0.004). In the overall cohort, the reduction in symptomatic UTI incidence did not reach statistical significance (49.2% vs. 36.9%, p = 0.092). In the pre-specified spinal cord injury (SCI) subgroup (n = 71), the intervention was associated with improved UTI-free survival (log-rank p = 0.03; adjusted HR 0.52, 95% CI 0.28–0.96, p = 0.037; treatment × SCI interaction p = 0.042). All adverse events were Clavien–Dindo Grade I. No major complications occurred. Conclusions: Proactive gentle cystoscopic debris removal was associated with reduced catheter blockage. A signal toward lower symptomatic UTI risk was observed in the SCI subgroup, but not in the overall cohort. Due to the self-selected design and residual confounding, these findings are hypothesis-generating. Full article

Background/Objectives: Pharmacists play a key role in managing urinary tract infection (UTI) symptoms by providing medications, self-care advice, and over-the-counter treatments, while referring patients to a doctor when necessary. This study aimed to examine the practices of community pharmacists in managing UTI symptoms and to gain insight into their attitudes toward antibiotic use for this condition. Methods: A cross-sectional study was conducted among community pharmacists in Serbia using a previously validated online questionnaire, assessed for content and face validity and pilot-tested among pharmacists. Results: A total of 430 community pharmacists participated in the study. Patients more often consulted pharmacists before visiting a doctor than after (median 5 vs. 3 per week; p < 0.001). For uncomplicated UTIs, pharmacists primarily recommended increased fluid intake (92.8%), herbal teas (94.7%), and food supplements (85.6%), whereas for complicated UTIs, most referred patients to a doctor (95.4%). Attitudes, perceived competence, and support for over-the-counter antibiotic availability were significantly associated with gender, years of experience, and specialization. Pharmacists who agreed that antibiotics are the most effective treatment for uncomplicated urinary tract infections were more likely to refer patients to a doctor (p < 0.01). Conclusions: Pharmacists are frequently consulted for UTI management and emphasize non-antibiotic approaches for uncomplicated cases. Their attitudes influence counseling practices, highlighting the need for standardized UTI counseling services, antimicrobial stewardship education, and structured communication training to support appropriate antibiotic use. Full article

Background/Objectives: Urinary tract infections (UTIs) represent the most common infectious complication following kidney transplantation. An increasing number of UTIs are caused by multidrug-resistant organisms (MDROs). The role of intestinal MDRO colonisation in complicated urinary tract infections (cUTIs) among kidney transplant recipients is not fully understood. Methods: We conducted a retrospective, single-centre study of kidney or kidney–pancreas transplant recipients hospitalised for infectious diseases. Each hospitalisation was analysed as a separate event. Routine rectal screening targeted carbapenem-resistant Enterobacterales and vancomycin-resistant/vancomycin-variable enterococci. Results: The study included 65 hospitalisations from 52 kidney transplant recipients, with some patients contributing multiple admissions. cUTIs accounted for 63.1% of admissions, and 22.0% of cUTIs were associated with concomitant bloodstream infection (BSI). The most frequently isolated pathogens were Klebsiella pneumoniae (58.8%) and Escherichia coli (41.2%). Extended-spectrum β-lactamase (ESBL) production was detected in 50% of E. coli isolates, while carbapenemase production was identified in 60% of K. pneumoniae isolates. MDRO rectal carriage was detected in 43.1% of cases and was more frequent in cUTI than in other infections (53.7% vs. 25.0%, p = 0.024). Carbapenemase-producing K. pneumoniae (CP-KP) rectal carriage was also more frequent in cUTI (31.7% vs. 4.2%, p = 0.011), but did not remain statistically significant after adjustment for urinary stent presence (odds ratio 7.1, 95% CI 0.7–66.2; p = 0.087). Nevertheless, CP-KP rectal carriage was associated with CP-KP cUTI aetiology (PPV 75.0%; NPV 86.4%). The median length of hospital stay (LoS) was 15 days. In multivariable analysis, a longer median LoS was associated with BSI (12.2 days; 95% CI: 0.8–23.6; p = 0.037), urinary stent presence (6.8 days; 95% CI: 1.5–12.2; p = 0.014), and older age (2.3 days; 95% CI: 0.7–4.0; p = 0.007). Conclusions: Rectal CP-KP colonisation may represent a potential marker of cUTI risk, although its independent association was not confirmed after adjustment. These findings should be interpreted with caution, given the study design and sample size and require confirmation in larger prospective studies. Rectal screening may contribute to early risk stratification, whereas its role in guiding empirical therapy remains to be prospectively evaluated. Full article

Background/Objectives: Urinary tract infections (UTIs) are among the most common bacterial infections in children and represent a leading indication for antibiotic prescribing across inpatient, emergency department, and outpatient settings. Despite the availability of multiple international guidelines, prescribing practices for pediatric UTI frequently deviate from evidence-based recommendations in antibiotic selection, route of administration, and duration of therapy. These suboptimal practices contribute to the emergence of resistant uropathogens, including extended-spectrum β-lactamase-producing organisms, and highlight the need for a comprehensive stewardship approach specific to this population. Methods: A literature search was performed using PubMed and MEDLINE from January 2000 to May 2026 using the following search terms: urinary tract infection, children, pediatrics, antibiotic stewardship, antimicrobial resistance, diagnosis, treatment, duration, prophylaxis, and intravenous-to-oral transition. Thirteen active international guidelines published between 2011 and 2025 were identified and evaluated with specific emphasis on the integration of antibiotic stewardship principles. Clinical trials, systematic reviews, meta-analyses, and quality improvement studies addressing stewardship-relevant outcomes in pediatric UTI were included. Case reports were excluded. Results: Comparative analysis of 13 international UTI treatment guidelines demonstrated substantial variation in diagnostic criteria, treatment duration, and prophylaxis recommendations, with most guidelines predating the SCOUT, STOP, and INDI-UTI randomized controlled trials. Diagnostic stewardship interventions targeting urine collection methods, urinalysis-guided treatment decisions, and avoidance of antibiotic treatment for asymptomatic bacteriuria represented high-impact opportunities to reduce unnecessary antibiotic exposure. Oral antibiotic therapy was as effective as intravenous therapy for most children with pyelonephritis, and early intravenous-to-oral transition was supported by consistent randomized controlled trial evidence. A 5-day oral course may be reasonable for uncomplicated febrile UTI in children demonstrating clinical improvement, supported by the STOP trial, although the SCOUT trial did not meet its noninferiority margin despite a low absolute failure rate; 3 to 5 days was appropriate for uncomplicated cystitis. Antibiotic prophylaxis was not indicated in children with a normal urinary tract following a first febrile UTI and should be reserved for specific high-risk subgroups, with nitrofurantoin as the preferred agent. Formal antibiotic stewardship programs combining prospective audit and feedback, electronic health record integration, and prescriber education demonstrated measurable improvements in prescribing appropriateness for pediatric UTI. Gepotidacin, a first-in-class oral antibiotic approved in 2025 for uncomplicated UTI in female patients aged 12 years and older and weighing at least 40 kg, represented a limited option for eligible adolescents with resistant infections. Conclusions: Antibiotic stewardship for pediatric UTI addresses the full clinical pathway from diagnostic stewardship through prophylaxis rationalization. Evidence-based interventions targeting urine collection, urinalysis-guided decision-making, early intravenous-to-oral transition, duration optimization, and selective prophylaxis use can collectively reduce unnecessary antibiotic exposure without compromising patient outcomes. A dedicated stewardship-oriented pediatric UTI guideline, standardized resistance surveillance, and multicenter stewardship program evaluations with patient-centered outcomes are critical research priorities. Full article