Trends in Antimicrobial Susceptibility of Isolates in a Taiwanese Child Cohort with Urinary Tract Infections Between 2004 and 2018

The aim of this study was to investigate the annual incidence of isolates in urinary tract infections (UTIs) and the antimicrobial resistance of the third-generation cephalosporin (3GCs) to , including the factors associated with the resistance in hospitalized children in Taiwan. A large electronic database of medical records combining hospital admission and microbiological data during 2004-2018 was used to study childhood UTIs in Taiwan. Annual incidence rate ratios (IRR) of in children with UTIs and its resistant rate to the 3GCs and other antibiotics were estimated by linear Poisson regression. Factors associated with resistance to 3GCs were assessed through multivariable logistic regression analysis. UTIs occurred in 10,756 unique individuals among 41,879 hospitalized children, with 92.58% being community associated based on urine culture results reported within four days after the hospitalization. The overall IRR UTI was 1.01 (95% confidence interval (CI) 0.99-1.02) in community-associated (CA) and 0.96 (0.90-1.02) in healthcare-associated infections. The trend in 3GCs against increased (IRR 1.18, 95% CI 1.13-1.24) over time in CA-UTIs. Complex chronic disease (adjusted odds ratio (aOR), 2.04; 95% CI, 1.47-2.83) and antibiotics therapy ≤ 3 months prior (aOR, 1.49; 95% CI, 1.15-1.94) were associated with increased risk of 3GCs resistance to . The study results suggested little or no change in the trend of UTIs in Taiwanese youths over the past 15 years. Nevertheless, the increase in 3GCs-resistant was substantial. Interventions for children with complex chronic comorbidities and prior antibiotic treatment could be effective in reducing the incidence of 3GCs-resistant in CA-UTIs in this region and more generally.