| Discordance between antibiotic therapy and recurrent
urinary tract infections in young children with thirdgeneration
cephalosporin-resistant infections |
Yusin Kim1 
, Hyun A Lee1
, Gil Lee1
, Kyungseok Park2
, Ye Kyung Kim3
, Peong Gang Park1,4,5
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1Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
2Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Hospital Boramae Medical Center, Seoul, Korea
3Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
4Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
5Division of Pediatric Nephrology, Severance Children’s Hospital, Seoul, Korea |
Correspondence:
Peong Gang Park, Email: pedpeong@gmail.com
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Received: 27 June 2025 • Revised: 30 August 2025 • Accepted: 24 September 2025 |
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| Abstract |
Background
Third-generation cephalosporins remain
the empirical mainstay for pediatric urinary tract infections
(UTIs) in Korea, yet the resistance rate now approaches 30%,
thereby threatening treatment effectiveness.
Purpose
To determine whether completing a cephalosporin
regimen, despite in vitro resistance, increases early
UTI recurrence rates.
Methods
We retrospectively reviewed the cases of children
aged <24 months with their first Gram-negative UTI
admitted in 2020–2024. Three exposure groups were defined:
susceptible isolates treated with a third-generation
cephalosporin; resistant isolates that received ≥5 days of
antibiotics to which the isolated organism was susceptible
(concordant); and resistant isolates that received <5 days of
appropriate antibiotic therapy (discordant). The primary
outcome was UTI recurrence within 2 months. Kaplan-
Meier curves were generated, while multivariate Cox
models adjusted for age, fever, acute cortical defects, and
kidney anomalies were used to estimate hazard ratios
(HRs).
Results
Among 989 children (mean age, 4.4 months),
424 (42.9%) had cefotaxime-resistant isolates; of them,
76 (17.9%) received concordant therapy and 348 (82.1%)
received discordant therapy. The overall 2-month recurrence
rate was 15.4% (95% confidence interval [CI],
13.0–17.7). Compared to the susceptible group, the concordant
group did not show a significantly different relapse
rate (adjusted HR [aHR], 1.09; 95% CI, 0.67–1.78), whereas
the discordant group demonstrated an increased recurrence
risk (aHR, 1.42; 95% CI, 1.08–1.86). An analysis of
culture-confirmed recurrence yielded similar findings
(discordant therapy aHR, 1.82; 95% CI, 1.29–2.56). No significant
differences were observed when the analysis was
restricted to febrile recurrence.
Conclusion
Completing a third-generation cephalosporin
course when isolates are not susceptible to thirdgeneration
cephalosporins can increase early UTI recurrence
rates in Korean children. Reviewing susceptibility
on day 5 and switching to an active oral agent may reduce
recurrence and limit unnecessary broad-spectrum antibiotic
exposure. |
| Key Words:
Urinary tract infection, Antibiotic resistance,
Third-generation cephalosporin, Antibiotic therapy, Child |
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