Antibiotic Resistance Trends in Recurrent Paediatric Urinary Tract Infections: A Five-Year Single-Centre Experience

Background: Recurrent urinary tract infections (rUTIs) in children are increasingly complicated by antimicrobial resistance, leading to limited treatment options and chal-lenging prophylactic management. Continuous local monitoring of resistance trends is essential for evidence-based stewardship. Methods: This retrospective study analysed 130 episodes of recurrent paediatric UTI recorded between 2020 and 2024 at a tertiary hospital in Romania. Data were extracted using the ICD-10 code N39.0 and included demographic, clinical, and microbiological variables. Antimicrobial susceptibility testing followed CLSI standards. Associations between multidrug resistance (MDR) and clinical factors were assessed with χ² tests and Cramer’s V, and predictors of MDR were evaluated by multivariable logistic regression. Temporal trends in resistance were examined using logistic regression with year as a continuous variable, and results were validated with the non-parametric Cochran–Armitage linear-by-linear χ² trend test to strengthen analytical rigor. Proportions are presented with Wilson 95% confidence intervals (CIs). Results: MDR occurred in 48.5% of isolates (95% CI, 40.2–56.9) and ESBL in 20.9% (95% CI, 14.9–28.5). MDR was significantly associated with urinary tract malformations (χ² = 5.78, p = 0.016) and continuous antibiotic prophylaxis (χ² = 4.23, p = 0.040). Neither logistic nor Cochran–Armitage trend analyses demonstrated a significant temporal increase in MDR (OR per year = 0.94; 95% CI 0.75–1.17; p = 0.566; χ² = 0.89; p = 0.346). Conclusions: MDR and ESBL rates among children with recurrent UTIs remain high but stable. The combined use of parametric and non-parametric trend analyses confirmed the absence of a significant upward trajectory, underscoring the need for ongoing surveillance and stewardship to maintain antibiotic effectiveness in paediatric care.