Bacterial Uropathogens and Antimicrobial Susceptibility Patterns among Children at a Cambodian Tertiary Pediatric Hospital, January 2023 – June 2025

Antimicrobial resistance complicates empirical treatment of pediatric urinary tract infection (UTI), and local data from Cambodia remain limited. This study aimed to describe bacterial isolates from urine cultures in children with suspected UTI and their antimicrobial susceptibility patterns. This retrospective descriptive study was conducted at the National Pediatric Hospital, Cambodia, between January 2023 and June 2025. Children aged 0-15 years with suspected UTI and positive bacterial urine cultures were included. Fungal isolates were excluded because the study focused on bacterial uropathogens and antibacterial susceptibility patterns. Clinical, microbiological, susceptibility, and antibiotic-use data were extracted from medical records and microbiology reports. Among 3,209 children who underwent urine culture testing, 80 (2.5%) had positive cultures. After excluding 21 fungal isolates, 59 children (1.8%) with positive bacterial cultures were analyzed. The mean age was 5.9 years, and females predominated (38/59, 64.4%). Gram-negative bacteria accounted for 58/59 isolates (98.3%). Escherichia coli was the most common pathogen (48/59, 81.4%), followed by Klebsiella spp. (7/59, 11.9%). E. coli showed high resistance to ampicillin (44/48, 91.7%), trimethoprim-sulfamethoxazole (36/42, 85.7%), ceftriaxone (36/48, 75.0%), ceftazidime (31/44, 70.5%), ciprofloxacin (31/46, 67.4%), amoxicillin/clavulanic acid (27/47, 57.4%), and gentamicin (25/47, 53.2%). Lower resistance was observed to nitrofurantoin (1/37, 2.7%), amikacin (4/47, 8.5%), meropenem (7/44, 15.9%), and imipenem (8/44, 18.2%). Ceftriaxone was the most frequently used antibiotic during hospitalization (43/59, 72.9%), despite high ceftriaxone resistance among E. coli isolates. Gram-negative bacteria, mainly E. coli followed by Klebsiella spp., predominated among children with positive bacterial urine cultures. Frequent ceftriaxone use despite high E. coli resistance highlights the need for culture-guided treatment adjustment, ongoing local surveillance, and periodic review of empirical antibiotic recommendations. These findings should be interpreted as baseline surveillance data.