Search Results (2,411)

Background: Missed nursing care related to infection prevention and control compromises patient safety and reflects clinical practice gaps and organizational constraints. The COVID-19 pandemic intensified awareness of infection-control practices; however, whether this translated into sustained reductions remains unclear. Aim: To compare missed infection-control nursing care between the pre-/early-pandemic period (2019–2020) and the post-pandemic period (2026) and identify persistent omissions with implications for healthcare policy and management. Methods: A descriptive study was conducted among 1570 nurses, including 774 participants in Group A (2019–2020) and 796 in Group B (2026). Data were collected online using the Missed Infection Control Nursing Care Questionnaire, tested for reliability and validity in Greek. Data were analyzed using SPSS 25.0, with statistical significance set at α = 0.05. Results: Item-level analysis showed lower mean omission scores in 34/37 infection-control nursing care practices, with 26 statistically significant reductions. The largest decreases were observed for glove use during antibiotic preparation/administration (1.493 to 1.070), hand hygiene before medication administration (1.340 to 0.962), multidrug-resistant organism (MDRO) admission screening (1.849 to 1.481), and intravenous access hub disinfection (1.978 to 1.668). In 2026, key residual omissions involved urinary catheter care (31.2%), hub disinfection (33.2%), oral hygiene (30.9%), and environmental hygiene before meals (29.1%). Conclusions: Missed infection-control nursing care declined in the post-pandemic period, but system-dependent omissions persisted, highlighting the need for staffing adequacy, balanced workload allocation, environmental support, and routine integration of infection-prevention practices. Full article

One hundred and ninety free-ranging rat individuals from dozens of sampling areas (towns, farms, villages) were investigated for Leptospira infections. From the renal tissues (kidneys and urinary bladders), DNA was extracted, and the samples were screened by an lfb1-specific PCR assay. The PCR products were sequenced. One hundred and three (54.2%) of the samples proved to be positive. All detected Leptospires belonged to the pathogenic phylogenetic cluster, and only one species was detected: all 103 positive samples belonged to L. interrogans lfb1 species group 1. In parallel, 353 human samples (urine, anticoagulated blood, tissues) from 232 patients over the period 2022–2025 submitted with suspected Leptospira infections were tested by commercial multiplex real-time PCR kits. Twenty-nine (8%) positive samples were found, which were retested by lfb1-specific PCR. The quality of 20 PCR products was sufficient for sequencing, representing 14 individual patients. Among the 14 positive patients we identified two Leptospira species: L. kirschneri lfb1 species group 6 in one case and L. interrogans in 13 cases (one lfb1 species group 3 imported case, 12 lfb1 species group 2). Comparison of the lfb1 sequences obtained from rats (lfb1: 1) and human cases (lfb1: 2, 1: 3, 1: 6) indicated that, although rat populations maintain the pathogen in high prevalence, they could not be the sources of the identified human Leptospira infections. Full article

Background: Carbapenem-resistant Klebsiella spp. have emerged as major healthcare-associated pathogens worldwide, posing significant therapeutic and infection control challenges. Despite the growing burden of antimicrobial resistance, contemporary multicenter epidemiological data regarding carbapenem-resistant Klebsiella spp. in Türkiye remain limited. This study aimed to determine the culture-based prevalence of carbapenem-resistant Klebsiella spp. and to describe the clinical, microbiological, and institutional characteristics associated with these organisms. Materials and Methods: This multicenter cross-sectional point-prevalence study was conducted in seven tertiary-care hospitals located in different regions of Türkiye. On 19 February 2026, all hospitalized adult patients and microbiological cultures obtained on the study day were evaluated. Demographic, clinical, microbiological, antimicrobial treatment, infection control, and hospital-level data were collected using a standardized case report form. Culture-based prevalence estimates were calculated with 95% confidence intervals (CIs). Results: A total of 26 patients with carbapenem-resistant Klebsiella spp. colonization and/or infection were included. The mean age was 68.5 ± 14.1 years, and 61.5% were male. Most patients had at least one comorbidity (84.6%), and recent antibiotic exposure was common (88.5%). Urinary tract infection was the most frequently identified infection type (53.8%), followed by pneumonia (19.5%) and bloodstream infection (19.2%). Urinary catheterization was present in 73.1% of patients, while central venous catheters and mechanical ventilation were present in 46.2% and 34.6%, respectively. Ceftazidime–avibactam susceptibility results were available for 20 isolates, of which 12 (60.0%; 95% CI, 38.66–78.12) were resistant. Colistin susceptibility results were available for 17 isolates, of which four (23.5%; 95% CI, 9.56–47.26) were resistant. The culture-based prevalence of carbapenem-resistant Klebsiella spp. was 1.69% (95% CI, 1.16–2.46) among all cultures obtained on the study day and 8.94% (95% CI, 6.17–12.77) among culture-positive specimens. Conclusions: Carbapenem-resistant Klebsiella spp. remain important healthcare-associated pathogens in Türkiye, particularly among patients with substantial healthcare exposure, invasive device use, and recent antibiotic treatment. Continued surveillance, strengthened infection prevention measures, and expanded molecular characterization are essential for improving the understanding and control of antimicrobial resistance in the country. Full article

Serratia species are Gram-negative pathogens responsible for a wide range of nosocomial infections. This multicenter nationwide retrospective study aimed to describe the epidemiology, clinical characteristics, antimicrobial susceptibility, and outcomes of Serratia infections in pediatric oncology patients and hematopoietic stem cell transplantation (HSCT) recipients in Poland between 2012 and 2023. A total of 36 Serratia infection episodes were identified in patients under 20 years of age, including 30 cases (83.3%) in the oncological (OHD) group and six (16.7%) among HSCT recipients. The median age was 4.30 years. The most common underlying diseases were acute lymphoblastic leukemia (36.1%) and central nervous system tumors (16.7%). Bloodstream infections predominated in OHD patients (33.3%), whereas urinary tract infections were most frequent in HSCT recipients (83.3%). S. marcescens was the most commonly isolated species. More than half of isolates (53.3%) showed antimicrobial resistance, with extended-spectrum β-lactamase (ESBL)-producing strains in 26.7% and AmpC β-lactamase-producing strains in 13.3%. Multidrug resistance occurred in 30%. Treatment most often included amikacin, piperacillin/tazobactam, and carbapenems. Five deaths occurred in the OHD group and one in the HSCT group, none directly related to Serratia infection. Although uncommon, Serratia infections remain clinically relevant due to their high antimicrobial resistance, underscoring the need for antimicrobial stewardship. Full article

Background: Vancomycin-resistant enterococci (VRE) Enterococcus faecalis (E. faecalis) remains largely ampicillin-susceptible, yet broad-spectrum agents are frequently used empirically (i.e., daptomycin and linezolid). Despite its frequent susceptibility to ampicillin, VRE E. faecalis is often managed with broad-spectrum antimicrobials, raising concerns about overtreatment and antimicrobial stewardship. Resistance mechanisms vary, with vancomycin resistance mediated by vanA/vanB operons and beta-lactams by altered penicillin binding proteins. These distinct mechanisms help explain why VRE E. faecalis isolates may remain susceptible to ampicillin, supporting its potential use in clinical isolates. This study aims to describe the antibacterial susceptibility results of Enterococcus faecalis VRE and assess antibiotics use in clinical settings in a tertiary medical center. Methods: This was a single-center, retrospective, descriptive study of hospitalized and outpatient adults with Enterococcus faecalis VRE isolates identified between 1 June 2018 and 15 March 2025. We excluded individuals with concomitant non-Enterococcus faecalis VRE infections and those aged <18 years. Vancomycin resistance was defined by a minimum inhibitory concentration of >32 mcg/mL per the 35th edition of the Clinical and Laboratory Standards Institution breakpoints. Results: A total of 337 patients were screened; 114 met inclusion criteria. The cohort was 54% female, 50% Black, and 48% White, with 54% having hypertension, 36% diabetes, and 19% a history of multidrug-resistant organism carriage. The most common source of infection was urinary (67%), followed by skin and soft tissue infections and bone/joint infections (11% each). All isolates were vancomycin-resistant; 82% were susceptible to ampicillin, 84% to nitrofurantoin, 61% to daptomycin, and 70% to linezolid. Antimicrobial regimens varied, with daptomycin being the most used agent (19%). No patients in the aminopenicillin group experienced 30-day mortality, whereas two patients (3%) in the non-aminopenicillin group died within 30 days. Acute kidney injury occurred in four patients (29%) in the aminopenicillin group compared with four patients (7%) in the non-aminopenicillin group, representing a significantly higher incidence in the aminopenicillin group (p = 0.037). However, myalgia, elevated creatine phosphokinase, and thrombocytopenia were more common in the non-aminopenicillin group. Conclusions: Despite higher susceptibility to ampicillin and nitrofurantoin, daptomycin was the most used agent for VRE E. faecalis infections. These findings highlight a need for improved antimicrobial stewardship and further clinical studies to guide optimal therapy. Full article

Urinary tract infections (UTIs) sit at a leading edge of the antimicrobial-resistance (AMR) crisis, and Romania ranks among the most affected European countries, yet large single-center series of urinary isolates with complete antibiograms remain scarce. We describe the full resistance landscape of urinary pathogens at a Romanian tertiary hospital, with particular attention to multidrug-resistant Klebsiella and to the often-overlooked urease-positive organisms. We analyzed all positive urine cultures processed over 13 consecutive months (February 2025–February 2026). The first isolate per patient was the primary unit of analysis (n = 2331); the full isolate-level dataset (n = 3348) was analyzed secondarily. Resistance phenotypes (putative ESBL, carbapenem resistance, MDR, VRE) were derived from per-agent susceptibility data following Magiorakos et al., and resistance rates were calculated only on tested isolates. Associations were tested with chi-square/Fisher tests and Benjamini–Hochberg correction. A total of 3348 isolates from 2331 unique patients were analyzed (median age 68 years; 55% male). Escherichia coli predominated (40.5%), followed by Enterococcus spp. (22.2%) and Klebsiella spp. (18.9%). Among the first isolates, 15.3% were MDR; 16.7% of E. coli, Klebsiella and Proteus showed a putative ESBL phenotype; and 3.9% of Enterobacterales were carbapenem-resistant. Resistance was concentrated in Klebsiella (36.2% MDR, 22.8% putative ESBL, 14.7% carbapenem-resistant; all higher than E. coli, p < 0.001) and in Pseudomonas spp. (48.1% carbapenem-resistant). E. coli retained excellent activity to nitrofurantoin (1.2%), fosfomycin (1.2%; tested in a subset) and ertapenem (0.1%) despite high trimethoprim–sulfamethoxazole (31.5%) and fluoroquinolone (24.3%) resistance. Urease-positive organisms formed a distinct subgroup with high trimethoprim–sulfamethoxazole resistance but preserved carbapenem activity. The urinary resistance burden was substantial but uneven, concentrated in Klebsiella and Pseudomonas. These findings support a stratified, locally guided empirical strategy and combined stewardship–infection control efforts. Full article

Urogenital toileting practices for residents in nursing homes (NHs) and their implications for the occurrence of bacteriuria remain largely unknown. Our purpose was to assess urogenital toileting practices in NHs in our region and their association with bacteriuria and urinary culture contamination rates. NHs reported on the direction of urogenital cleaning with respect to the urinary meatus and related practices during resident care over 7 years (2017 to 2023). Linear mixed models were used to relate two urogenital cleaning techniques, with bacteriuria rates (positive urinary cultures per resident over a year) and urinary culture contamination proportions. Of the 111 participating NHs, 33% used a technique involving outward cleaning with respect to the urinary meatus. Of these, 50 institutions had 7-year urinary microbiological data available (10,602 cultures, 13,059 isolates). Escherichia coli (45%) was the most frequently isolated microorganism while 12.4% of all cultures were contaminated (>3 microorganisms). We did not observe any significant association between the cleaning technique and the bacteriuria rates. The technique involving outward cleaning away from the urinary meatus was associated with lower odds of urinary culture contamination (odds ratio = 0.15, 95% CI: 0.05–0.48, p < 0.01). Urogenital cleaning techniques varied across participating institutions. We observed an association with urinary culture contamination, but not with bacteriuria rates. These findings warrant further investigation. Full article

Background/Objectives: The clinical utility of renal ultrasound after pediatric urinary tract infection (UTI) remains controversial, particularly because not all ultrasonographic abnormalities have the same prognostic significance. This study aimed to determine whether nephrourological malformations identify the phenotype associated with greater subsequent clinical burden among children hospitalized with presumed UTI and interpretable renal ultrasound findings, and to differentiate this phenotype from non-malformative ultrasound abnormalities. Methods: A retrospective single-center hospital-based cohort study was conducted in children aged 2 months to 17 years hospitalized with a clinical diagnosis of UTI at a general hospital of the Mexican Social Security Institute between 2020 and 2025. The cohort included both microbiologically confirmed UTI cases and probable clinical/microbiologically unconfirmed UTI cases. Of 182 registered patients, 130 with interpretable renal ultrasound were included. The primary exposure was the presence of adjudicated nephrourological malformation. As a secondary exposure, within the subgroup without malformation, abnormal non-malformative ultrasound findings were compared with normal ultrasound findings. Outcomes included outpatient follow-up, subspecialty referral, and hospital readmission. Crude associations were expressed as relative risks (RR), and adjusted analyses were estimated using modified Poisson regression with HC3 robust errors. Results: Twenty-nine of 130 patients (22.31%) were classified as having nephrourological malformations, and 31 (23.85%) had abnormal non-malformative ultrasound findings. Malformations were associated with higher outpatient follow-up (79.31% vs. 44.55%; RR 1.78, 95% CI 1.34–2.37), greater subspecialty referral (79.31% vs. 49.50%; RR 1.60, 95% CI 1.22–2.10), and increased readmission (44.83% vs. 13.86%; RR 3.23, 95% CI 1.72–6.08). In adjusted models, malformations remained associated with follow-up (aRR 1.72, 95% CI 1.25–2.37), referral (aRR 1.59, 95% CI 1.17–2.16), and readmission (aRR 3.38, 95% CI 1.58–7.23). In contrast, abnormal non-malformative ultrasound findings showed no significant adjusted associations. Microbiologically confirmed UTI was present in 47/130 patients (36.15%), and malformations were more frequent in this subgroup than in probable/non-confirmed clinical UTI (34.04% vs. 15.66%; p = 0.027). Conclusions: In this single-center hospital-based cohort, subsequent clinical burden was concentrated in the nephrourological malformation phenotype rather than in the broader category of “abnormal ultrasound”. These findings suggest that renal ultrasound may serve as a useful prognostic stratification tool beyond its role as a nonspecific detector of abnormalities following pediatric UTI. Given the observational design, these associations should be confirmed in larger prospective studies. Full article

Fluoroquinolones are broad-spectrum, bactericidal antibacterial agents used in both human and veterinary medicine. Some human-approved drugs are used off label in veterinary medicine while veterinary-approved drugs are not used in humans. Veterinary-approved fluoroquinolones are used on both food and companion animals and against a wide range of clinical indications including infections of the urinary tract, respiratory tract, skin and skin structure, mammary gland and others. Not all veterinary-approved fluoroquinolones have the same clinical indication and it is important to understand these important differences. A recently approved for food animals agent called pradofloxacin is characterized as being dual targeting in that it simultaneously inhibits DNA gyrase (topoisomerase II) and Topoisomerase IV—two enzymes critical for DNA replication. Simultaneous targeting of two enzymes is argued to reduce the likelihood for resistance selection. This article reviews veterinary-approved fluoroquinolones including an overview of the drugs, in vitro activity including bactericidal properties, pharmacokinetic/pharmacodynamics, antimicrobial resistance, anti-inflammatory properties and clinical trial results. Appropriate use of this important class of antimicrobial agents is essential for clinical success and long-term viability of these compounds. Full article

Background: Catheter-associated urinary tract infections (CAUTIs) are a major concern in patients with long-term indwelling urinary catheters, especially those with neurogenic bladder. This study assessed whether proactive cystoscopic removal of bladder debris reduces symptomatic UTI incidence and catheter blockage. Methods: This prospective, self-selected cohort study was conducted between January 2022 and December 2025 at a tertiary center in Taiwan. Enrollment occurred from January 2022 to June 2024, with follow-up completed by December 2025. Patients chose standard CDC-guided care (control, n = 63) or standard care plus flexible cystoscopy every 3 months for gentle low-volume evacuation (<100 mL normal saline) of dependent bladder debris (intervention, n = 141). Inverse probability of treatment weighting (IPTW) was used to address selection bias. Symptomatic UTIs were prospectively recorded using strict criteria. Cumulative incidence was analyzed with Kaplan–Meier methods and multivariable Cox regression. Results: After IPTW, baseline characteristics were well balanced. Median follow-up was 26 months (IQR 18–34). The incidence of catheter blockage was significantly lower in the intervention group (7.8% vs. 22.2%, p = 0.004). In the overall cohort, the reduction in symptomatic UTI incidence did not reach statistical significance (49.2% vs. 36.9%, p = 0.092). In the pre-specified spinal cord injury (SCI) subgroup (n = 71), the intervention was associated with improved UTI-free survival (log-rank p = 0.03; adjusted HR 0.52, 95% CI 0.28–0.96, p = 0.037; treatment × SCI interaction p = 0.042). All adverse events were Clavien–Dindo Grade I. No major complications occurred. Conclusions: Proactive gentle cystoscopic debris removal was associated with reduced catheter blockage. A signal toward lower symptomatic UTI risk was observed in the SCI subgroup, but not in the overall cohort. Due to the self-selected design and residual confounding, these findings are hypothesis-generating. Full article

Background/Objectives: Pharmacists play a key role in managing urinary tract infection (UTI) symptoms by providing medications, self-care advice, and over-the-counter treatments, while referring patients to a doctor when necessary. This study aimed to examine the practices of community pharmacists in managing UTI symptoms and to gain insight into their attitudes toward antibiotic use for this condition. Methods: A cross-sectional study was conducted among community pharmacists in Serbia using a previously validated online questionnaire, assessed for content and face validity and pilot-tested among pharmacists. Results: A total of 430 community pharmacists participated in the study. Patients more often consulted pharmacists before visiting a doctor than after (median 5 vs. 3 per week; p < 0.001). For uncomplicated UTIs, pharmacists primarily recommended increased fluid intake (92.8%), herbal teas (94.7%), and food supplements (85.6%), whereas for complicated UTIs, most referred patients to a doctor (95.4%). Attitudes, perceived competence, and support for over-the-counter antibiotic availability were significantly associated with gender, years of experience, and specialization. Pharmacists who agreed that antibiotics are the most effective treatment for uncomplicated urinary tract infections were more likely to refer patients to a doctor (p < 0.01). Conclusions: Pharmacists are frequently consulted for UTI management and emphasize non-antibiotic approaches for uncomplicated cases. Their attitudes influence counseling practices, highlighting the need for standardized UTI counseling services, antimicrobial stewardship education, and structured communication training to support appropriate antibiotic use. Full article

Background: Constipation in children often presents with non-specific symptoms, which can complicate its recognition in the pediatric emergency department (PED). Aim: This study aimed to characterize the clinical presentations, diagnostic context and testing patterns of children discharged with constipation from a tertiary pediatric emergency center. Methods: A retrospective analysis of medical records of patients under 18 years of age was conducted for patients who presented to the PED of a tertiary hospital in northern Poland from 2021–2024 and were ultimately discharged as K59.0 ICD-10 code (constipation). Demographic data, symptoms reported upon admission, and laboratory and imaging tests performed were collected and reviewed. Results: PED visits discharged with ICD-10 code K59.0 accounted for 2.97% of all 34,278 PED visits during study period. Among 1017 patients discharged with ICD-10 code K59.0, only 26.5% reported constipation as their main complaint. The most common complaints were abdominal pain (61.6%), vomiting (14.4%), and urinary symptoms (4.9%). Commonly suspected initial diagnoses were urinary tract infections or acute appendicitis. More complete documentation of constipation-related symptoms showed an exploratory association with less intensive diagnostic testing. Conclusions: Constipation should be routinely considered in children presenting to the PED with abdominal pain, vomiting, urinary symptoms, or rectal bleeding, even when bowel problems are not the main complaint. Structured history taking supported by simple diagnostic tools could help standardize assessment and support patient selection for further testing, although prospective studies are needed to determine clinical outcomes. Full article

Background/Objectives: Urinary tract infections (UTIs) represent the most common infectious complication following kidney transplantation. An increasing number of UTIs are caused by multidrug-resistant organisms (MDROs). The role of intestinal MDRO colonisation in complicated urinary tract infections (cUTIs) among kidney transplant recipients is not fully understood. Methods: We conducted a retrospective, single-centre study of kidney or kidney–pancreas transplant recipients hospitalised for infectious diseases. Each hospitalisation was analysed as a separate event. Routine rectal screening targeted carbapenem-resistant Enterobacterales and vancomycin-resistant/vancomycin-variable enterococci. Results: The study included 65 hospitalisations from 52 kidney transplant recipients, with some patients contributing multiple admissions. cUTIs accounted for 63.1% of admissions, and 22.0% of cUTIs were associated with concomitant bloodstream infection (BSI). The most frequently isolated pathogens were Klebsiella pneumoniae (58.8%) and Escherichia coli (41.2%). Extended-spectrum β-lactamase (ESBL) production was detected in 50% of E. coli isolates, while carbapenemase production was identified in 60% of K. pneumoniae isolates. MDRO rectal carriage was detected in 43.1% of cases and was more frequent in cUTI than in other infections (53.7% vs. 25.0%, p = 0.024). Carbapenemase-producing K. pneumoniae (CP-KP) rectal carriage was also more frequent in cUTI (31.7% vs. 4.2%, p = 0.011), but did not remain statistically significant after adjustment for urinary stent presence (odds ratio 7.1, 95% CI 0.7–66.2; p = 0.087). Nevertheless, CP-KP rectal carriage was associated with CP-KP cUTI aetiology (PPV 75.0%; NPV 86.4%). The median length of hospital stay (LoS) was 15 days. In multivariable analysis, a longer median LoS was associated with BSI (12.2 days; 95% CI: 0.8–23.6; p = 0.037), urinary stent presence (6.8 days; 95% CI: 1.5–12.2; p = 0.014), and older age (2.3 days; 95% CI: 0.7–4.0; p = 0.007). Conclusions: Rectal CP-KP colonisation may represent a potential marker of cUTI risk, although its independent association was not confirmed after adjustment. These findings should be interpreted with caution, given the study design and sample size and require confirmation in larger prospective studies. Rectal screening may contribute to early risk stratification, whereas its role in guiding empirical therapy remains to be prospectively evaluated. Full article

Background: Medical device-associated infections represent a major component of healthcare-associated infections. Biofilm formation promotes microbial persistence on device surfaces, reduces antimicrobial susceptibility, and contributes to multidrug resistance (MDR), complicating diagnosis and treatment. Materials and Method: This study investigated biofilm production and antimicrobial resistance in microorganisms recovered from 100 indwelling and implantable medical devices, including urinary and venous catheters, urethral stents, catheter tips, and orthopedic or prosthetic materials, collected at a tertiary-care hospital (AOU “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy). Microbiological cultures were performed using direct and enrichment methods. Microbial identification was carried out by MALDI-TOF MS, antimicrobial susceptibility testing by VITEK^® (bioMérieux, Marcy-l'Étoile, France) 2 according to EUCAST criteria, and biofilm production was assessed using the crystal violet tissue culture plate assay. MDR status was defined according to international guidelines. Results: Microbial growth was detected in the majority of analized devices, frequently with polymicrobial contamination. Within the study cohort, coagulase-negative staphylococci (CoNS) were the most frequently recovered microorganisms (20%), followed by Klebsiella pneumoniae (10%), Candida albicans (9%), Staphylococcus aureus (9%), Enterococcus faecalis (8%), and Escherichia coli (8%). A significant association was observed between multidrug resistance and biofilm production, with MDR isolates showing a markedly higher likelihood of being biofilm producers compared with non-MDR isolates (OR 9.50; 95% CI 2.72–42.96; p < 0.005). Biofilm formation also differed significantly among device types (p = 0.028). Conclusions: These findings indicate a high prevalence of biofilm-producing MDR microorganisms among isolated recovered from medical devices in our cohort and highlight a significant association between MDR phenotype and biofilm production. These results provide a microbiological characterization of device-associated isolates that may support future studies on infection dynamics and control strategies. Full article

Background: Vesicoureteral reflux (VUR) is a common pediatric urologic disorder associated with recurrent febrile urinary tract infections, renal scarring, hypertension, and potential long-term renal morbidity. Postoperative outcomes after ureteral reimplantation may be influenced by reflux grade, reflux etiology, bladder function, renal status, operative technique, surgeon experience, and follow-up intensity. However, real-world evidence from low- and middle-income healthcare settings remains limited, particularly for surgically treated children with high-grade VUR. Objective: To describe postoperative outcomes after ureteral reimplantation in children with Grade III–V VUR and to explore the association of VUR grade and surgical approach with reflux resolution, recurrence, and reintervention in a surgically selected pediatric cohort. Methods: We conducted a retrospective cohort study at a tertiary pediatric referral center in Ecuador. The study included 90 children aged 0 to 15 years with Grade III–V VUR confirmed by voiding cystourethrography who underwent open or laparoscopic ureteral reimplantation between January 2019 and January 2024. Demographic, clinical, imaging, and surgical variables were extracted from medical records. Postoperative outcomes included reflux resolution, recurrence, and reintervention. Logistic regression models were used as exploratory analyses only. Because the cohort included only operated patients, treatment allocation was nonrandomized, event numbers were limited, and several relevant prognostic variables were incompletely documented, adjusted estimates were interpreted cautiously and were not used to infer causality. Results: Overall reflux resolution was achieved in 68 of 90 patients (75.6%), recurrence occurred in 12 patients (13.3%), and reintervention was required in 8 patients (8.9%). Resolution rates were similar after open and laparoscopic surgery (44/59, 74.6% vs. 24/31, 77.4%; p = 0.766). Recurrence was numerically lower after laparoscopic than open reimplantation, but the difference was not statistically significant (2/31, 6.5% vs. 10/59, 16.9%; p = 0.164). Reintervention rates were also similar between groups (3/31, 9.7% vs. 5/59, 8.5%; p = 0.849). In exploratory multivariable analysis, Grade V VUR was associated with lower odds of reflux resolution (OR, 0.06; 95% CI, 0.01–0.40; p = 0.003) and higher odds of recurrence (OR, 16.69; 95% CI, 1.88–148.32; p = 0.012) compared with Grade III VUR. Surgical approach was not independently associated with resolution, recurrence, or reintervention. The small Grade V subgroup, the limited number of recurrence and reintervention events, and the wide confidence intervals indicate substantial statistical imprecision. Conclusions: In this surgically treated pediatric cohort from a tertiary referral center in Ecuador, ureteral reimplantation was associated with reflux resolution in approximately three-quarters of patients. Higher reflux grade, particularly Grade V disease, was associated with less favorable postoperative outcomes in exploratory analyses, but these findings should not be interpreted as causal or definitive because of the small subgroup size, limited event numbers, selection bias, and incomplete documentation of reflux etiology, bladder dysfunction, renal scarring, renal function, surgeon experience, and follow-up duration. Open and laparoscopic approaches showed comparable resolution and reintervention rates, while the lower recurrence observed after laparoscopy did not reach statistical significance. Future prospective studies should standardize outcome definitions, distinguish imaging-confirmed from clinically documented resolution, report follow-up duration, and account for reflux etiology, bladder function, renal status, surgical experience, and healthcare access. Full article