Children with recurrent urinary tract infections: who are they and why do we need better prevention options?

BACKGROUND: Recurrent UTIs (rUTIs) in children can lead to renal scarring and chronic renal failure, if not managed early. The current standard of care involves antibiotic prophylaxis, which benefits remain controversial. There is a need for new interventions, other than antimicrobial use, to reduce the occurrence of rUTIs as well as the identification of groups to target. Our objective was to describe the pediatric population most susceptible to rUTIs, including renal scarring and adverse events associated with prolonged antibiotic use. METHOD: We conducted a single-centre retrospective chart review of patients with rUTIs, diagnosed with urinary tract abnormalities or functional disorders, followed at the Centre hospitalier universitaire (CHU) Sainte-Justine urology clinic between January 2015 and December 2020. We described the population and evaluated the antimicrobial usage and uropathogens resistance patterns. RESULTS: Identified patients with rUTI (n = 107) had underlying medical conditions such as Spina Bifida or neurogenic bladder (31%), double collecting system (22%), vesicoureteral reflux (42%) and ureteropelvic junction obstruction (7%). Almost all patients (87%) were prescribed antimicrobial prophylaxis, and a significant proportion developed resistance, with 70% of breakthrough UTIs being resistant to at least one drug, and 41% demonstrating multi-drug resistance. CONCLUSION: While most patients received prophylaxis, it was not universally effective, leading to persistent concerns like renal scarring and adverse events associated with prolonged antimicrobial use. There is a critical need for the development of new strategies to prevent rUTI that would minimize reliance on antibiotic prophylaxis, given the escalating global threat of antimicrobial resistance.