The empirical purpose of antibacterial treatment of urinary tract infection in children: argumentation of choice and prognosis of antibiotic resistance risk
Keywords:urinary tract infection, antibacterial therapy, empirical choice
AbstractJustified 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.
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