The empirical purpose of antibacterial treatment of urinary tract infection in children: argumentation of choice and prognosis of antibiotic resistance risk

Authors

  • T. V. Budnik Shupyk National Medical Academy of Postgraduate Academy, Kyiv, Ukraine, Ukraine https://orcid.org/0000-0003-3956-3903
  • L. V. Kvashnina SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova NAMS of Ukraine», Kyiv, Ukraine https://orcid.org/0000-0001-7826-4880
  • M. D. Shpyt City Clinical Hospital No. 1, Kyiv, Ukraine, Ukraine
  • Yu. Yu. Rudyk City Clinical Hospital No. 1, Kyiv, Ukraine, Ukraine
  • V. O. Androsov City Clinical Hospital No. 1, Kyiv, Ukraine, Ukraine

DOI:

https://doi.org/10.15574/PP.2020.81.70

Keywords:

urinary tract infection, antibacterial therapy, empirical choice

Abstract

Justified empirical administration of an antibiotic to a child with a urinary tract infection (UTI) is a very important and complex issue. The prevalence of antibiotic resistance (ABR) among Escherichia coli strains makes it almost impossible for the etiotropy of UTI to start therapy. There is an urgent need for dynamic monitoring of Escherichia coli sensitivity, to study the trends of ABR development and its prognosis to understand the management mechanisms.
Purpose — to study of the dynamics of the sensitivity of Escherichia coli strains, trends in the development of ABR with the assessment of the future outlook among children with UTI.
Patients and methods. The study involved 1044 children with UTI from 1 month of age to 18 years. Patient screening and interpretation of the results were conducted within the framework of the Helsinki Declaration of Human Rights. The study design envisaged 3 comparison groups: 1 group — children in 2009 (n=337), 2 group — 2014 (n=328) and 3 group — 2019 (n=379).
Results. Escherichia coli was recognized as the leading uropathogen in all observation groups: in 1 group its share was 47% (158/337), in 2 group — 64% (210/328) and in 3 group — 66.5% (252/379). The prevalence of antibacterial resistance of Escherichia coli strains and the high dynamics of its growth are shown. Thus, the level of Escherichia coli resistance in 2019 was 70±4.06% (176/252). This was 11% > compared to 2014 and 18.8% > compared to 2009. The proportion of polyresistant strains also tended to increase: in 2009, it was 26.2±12.73% (44/168), in 2014 — 26.6±11.24% (56/210), p>0.05 and in 2019 — 28±9.97% (70/252), p>0.05. The relative risk of ABR in 2019 was 1.6 times higher than in 2014 (RR2019=2,208±0.207 [1.473; 3.310], p<0.05 vs RR2014=1.375±0.209 [0.913; 2.063]) and 3 times — compared to 2009 (RR2009=0.727±0.209 [0.483; 1.095]). Ampicillin and amoxicillin showed equally low levels of sensitivity (3.5±32.14% (9/252)). Only every other child confirmed sensitivity to cefuroxime (53.6±5.76% (135/252)). Relatively high levels of susceptibility to ceftazidime and ciprofloxacin were 77.4±3.34% (195/252) and 83±2.81% (209/252), respectively, and at the same time, rapid rates of resistance have been almost twice as high as in the last 5 years. Furazidine K had a high sensitivity of 85.7±2.53% (216/252), the lowest level of the overall resistance of 14.3±15.15% (36/252) and a slow rate of its formation. An unfavorable prognosis for the increase of the relative risk of ABR in 2.9–3.7 times among patients with UTI in the next 5–10 years was determined, provided that the existing diagnostic and treatment approaches were maintained.
Conclusions. The findings of the study are important for understanding the clinical decision regarding the benefits of antibacterial therapy and optimizing its empirical choice for a patient with UTI.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest were declared by the authors.

References

Ahn DH, Kim KW, Cho HK, Tchah H, Jeon IS, Ryoo E, Sun YH. (2015). Febrile Urinary Tract Infections Caused by Community-Acquired Extended-Spectrum beta-Lactamase-Producing and-Nonproducing Bacteria: A Comparative Study. Pediatr Infect Vaccine. 22: 29—35. https://doi.org/10.1016/j.eimc.2016.01.012; PMid:26976379.

Alberici I, Bayazit AK, Drozdz D, Emre S, Fischbach M, Harambat J et al. (2015). Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group. Eur J Pediatr. 174: 783—790. https://doi.org/10.1007/s00431-014-2459-3; PMid:25428232.

Aragon IM, Herrera-Imbroda B, Queipo-Ortuno MI, Castillo E, Del Moral JS, Gomez-Millan J, Yucel G, Lara MF. (2018, Jan). The Urinary Tract Microbiome in Health and Disease. Eur Urol Focus. 4 (1): 128—138. https://doi.org/10.1016/j.euf.2016.11.001; PMid:28753805.

Brubaker L, Wolfe AJ. (2017, Feb). Microbiota in 2016: Associating infection and incontinence with the female urinary microbiota. Nature Reviews Urology. 14 (2): 72—74. https://doi.org/10.1038/nrurol.2016.262; PMid:28050013 PMCid:PMC5522000.

Bryce A, Costelloe C, Hawcroft C et al. (2016). Faecal carriage of antibiotic resistant Escherichia coli in asymptomatic children and associations with primary care antibiotic prescribing: a systematic review and meta-analysis. BMC Infect Dis. 16: 359. https://doi.org/10.1186/s12879-016-1697-6; PMid:27456093 PMCid:PMC4960702.

Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C. (2016). Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ. 15: 939—945. https://doi.org/10.1136/bmj.i939; PMid:26980184 PMCid:PMC4793155.

Kim SH, Lee JA. (2015). The impact of the antibiotic burden on the selection of its resistance among gram negative bacteria isolated from children. Pediatr Infect Vaccine. 22: 178—185. https://doi.org/10.14776/piv.2015.22.3.178.

Lee SJ. (2018, Dec). Recent advances in managing lower urinary tract infections. F1000Res. 21; 7. pii: F1000 Faculty Rev-1964. https://doi.org/10.12688/f1000research.16245.1; PMid:30613378 PMCid:PMC6305210.

Magistro G, Stief CG. (2019, Jan). The Urinary Tract Microbiome: The Answer to All Our Open Questions? Eur Urol Focus. 5 (1): 36—38. https://doi.org/10.1016/j.euf.2018.06.011; PMid:30042043.

Martin Bland. (2015). An introduction to medical statistics: Oxford University Press, 4th edition. 464. ISBN 978-0-19-958992-0.

Whiteside SA, Razvi H, Dave S, Reid G, Burton JP. (2015, Feb). The microbiome of the urinary tract — a role beyond infection. Nat Rev Urol. 12(2): 81—90. https://doi.org/10.1038/nrurol.2014.361; PMid:25600098

Downloads

Issue

No. 1(81) (2020): Ukrainian Journal of Perinatology and Pediatrics

Section

Original articles

License

The policy of the Journal “Ukrainian Journal of Perinatology and Pediatrics” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).

Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.

Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.

The use of published materials for commercial purposes is strongly prohibited.