BackgroundUrinary tract infections (UTIs) in children are very common. They are often associated with a high risk of sepsis and death. In recent years, antibiotic-resistant uropathogensESKAPE(Enterococcus faecium,Staphylococcus aureus,Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa, andEnterobacteriaceae) are increasingly encountered in UTIs. These bacteria, usually multidrug-resistance (MDR), extensive drug-resistance (XDR), pandrug-resistance (PDR), Extended-spectrum cephalosporin-resistance (ESC), Usual Drug Resistance (UDR), Difficult-to-Treat Resistance (DTR) and Carbapenem-resistance Enterobacteriales (CRE), represent a global threat for the management of paediatric UTIs. The aim of this study was to determine the epidemiology of community origin and antibiotic sensitivity of majorESKAPEuropathogens in paediatric UTIs in South-East Gabon.MethodsThe study involved 508 children aged 0–17 years. Identification of bacterial isolates was carried out using Vitek-2 compact automated system and the antibiogram with the disk diffusion and microdilution methods according to the European Committee on Antimicrobial Susceptibility Testing recommendations. Logistic regression analysis was used to assess the impact of patients' socio-clinical characteristics on uropathogens phenotype in both univariate and multivariate analysis.ResultsThe prevalence of UTIs was 59%.E. coli(35%) andK. pneumoniae(34%) were the mainESKAPEinvolved in UTIs followed byEnterococcusspp. (8%) andS.aureus (6%). Among majorESKAPE, DTR-E. coli(p= 0.01), CRE-E. coli(p= 0.02) and XDR-E. coli(p= 0.03), Trimethoprim-sulfamethoxazole-resistant bacteria (p= 0.03) were associated with abdomino-pelvic pain. While MDR-E. coli(p< 0.001), UDR-E. coli(p= 0.02),ESC-E. coli(p< 0.001), MDR-Enterococcus(p= 0.04),UDR-Enterococcus(p= 0.02), bacteria resistant to Ampicillin (p< 0.01), Cefotaxime (p= 0.04), Ciprofloxacin (p< 0.001), Benzylpenicillin (p= 0.03) and Amikacin (p= 0.04) were more frequent among male children. MDR-Enterococcus(p< 0.01), bacteria resistant to Amoxicillin-clavulanic acid (p= 0.03), Cefalotin (p= 0.01), Ampicillin (p= 0.02) and Gentamicin (p= 0.03) were associated with treatment failure. In addition, Trimethoprim-sulfamethoxazole-resistant bacteria (p= 0.03) was associated with recurrent UTIs while those resistant to Ciprofloxacin was associated with pollakiuria (p= 0.01) and urinary burning (p= 0.04). Furthermore, UDR-K. pneumoniae(p= 0.02) was more frequent in neonates and infants.ConclusionThis study determined the epidemiology ofESKAPEuropathogens in paediatric UTIs. It found a high prevalence of paediatric UTIs associated with children’s socio-clinical characteristics and diverse bacterial antibiotic resistance phenotypes.