Antimicrobial Resistance in Pediatric UTIs: Molecular Profiles, Clinical Burden, and Public Health Implications of ESBL-Producing Uropathogens

Urinary tract infections (UTIs) remain a common and serious health challenge among pediatric populations, particularly in low- and middle-income countries. The emergence of extended-spectrum beta-lactamase (ESBL)-producing uropathogens significantly complicates treatment, increases the risk of complications, and burdens already fragile healthcare systems. This review provides a comprehensive analysis of the epidemiology, molecular mechanisms, clinical impact, and treatment challenges associated with ESBL-producing Enterobacteriaceae in pediatric UTIs, with a focused lens on Nigeria and the broader Sub-Saharan African region. We examine the predominance of Escherichia coli and Klebsiella pneumoniae as key ESBL producers, highlight the molecular dominance of CTX-M-15 and co-existing resistance determinants, and discuss the role of clonal expansion and horizontal gene transfer in the spread of resistance. Regional surveillance data reveal alarming ESBL prevalence rates of 40–75%, with multidrug resistance further narrowing treatment options. The implications are profound—ranging from delayed treatment and increased hospitalization to long-term renal complications in children. Despite the availability of phenotypic and molecular diagnostics, challenges persist due to limited access, infrastructural gaps, and under-resourced healthcare systems. This review underscores the urgent need for improved antimicrobial stewardship, investment in rapid diagnostics, and the establishment of pediatric-specific treatment guidelines. Addressing the burden of ESBL-producing uropathogens in Nigerian children is critical for safeguarding individual patient outcomes and mitigating the regional and global spread of antimicrobial resistance.