Urinary tract infections in newborn children: microbial landscape and antibiotic resistance problems
DOI:
https://doi.org/10.15574/PS.2021.72.56Keywords:
Urinary tract infection, newborn babies, urinary tract abnormalities, antibiotic resistanceAbstract
Urinary tract infection is one of the most common bacterial infections in children, which in 30% of cases may be the first manifestation of the presence of congenital malformations of the urinary tract and urodynamic disorders in a child. Late diagnosis, initiation of therapy, and the choice of an inadequate antimicrobial drug increase the risks of disease progression, development of nephrosclerosis and patient disability.
Purpose – to study the microbial landscape in urinary tract infections, its antibiotic resistance in newborns with anomalies in the development of the urinary system.
Materials and methods. The results of microbiological examination of urine in newborns with urinary tract infections against the background of anomalies in the development of the urinary tract, which are being treated in intensive care units and neonatal pathology in the period 2016–2020, have been analyzed.
Results. The main causative agents of urinary tract infections in newborns with anomalies of the urinary system are Enterobacterales (63.4%), 13.8% are producers of extended spectrum beta-lactamases. Cefoperazone/sulbactam, amikacin, meropenem and nitrofurantoin were most active against Escherichia coli. In relation to other representatives of the order Enterobacterales, only amikacin was highly active. The strains of Enterococcus spp., Detected in 20%, were resistant to reserve vancomycin in every fourth case. Representatives of non-fermenting gram-negative bacteria were found in 6.4% of cases, resistance to the main titrated antibiotics ranged from 44.4% to 100%.
Conclusions. The main causative agents of urinary tract infections in newborns with anomalies of the urinary system are representatives of the order Enterobacterales, Enterococcus spp. and non-fermenting gram-negative bacteria, which were characterized by high resistance, including to reserve antibiotics. The high indices of resistance of the isolated microflora make it difficult to choose an effective antibacterial therapy in this category of patients and in most cases requires combined antibiotic therapy.
The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
References
Beloborodov VB, Gusarov VG, Dekhnich АV et al. (2020). Diagnostics and antimicrobial therapy of the infections caused by multiresistant microorganisms. Guidelines of the Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), and NGO Russian Sepsis Forum. Messenger of Anesthesiology and Resuscitation. 17 (1): 52-83. https://doi.org/10.21292/2078-5658-2020-16-1-52-83
Bilgili G, Yuksel MB. (2015). Urinary tract infections in newborns. Medical Science and Discovery. 2 (1): 124. https://doi.org/10.17546/msd.71668
Chugunova OL, Dumova SV. (2010). Features of diseases of the urinary system in young children. Pharmacotherapy of Childhood Diseases: A Guide. Moscow: Medical Information Agency: 704-734.
Chugunova OL, Shumikhina MV, Dumova SV. (2013). Current overview of the urinary system infection in newborns and infants. Pediatria. 4 (42): 38-47.
Dakic D, Dragas LJ, Rudanovic R. (2014). Urinary Tract Infections In Newborns. Archives of Disease in Childhood. 99: A422. https://doi.org/10.1136/archdischild-2014-307384.1173
Edelstein MV, Sukhorukova MV, Skleenova EYu, Ivanchik NV, Mikotina AV, Shek EA, Dekhnich AV, Kozlov RS, «MARATHON » study group. (2017). The antibiotic resistance of nosocomial strains of Pseudomonas aeruginosa in Russian hospitals: the results of multicenter epidemiological study MARAFON 2013-2014. Clinical microbiology and antimicrobial chemotherapy. 19 (1): 37-41.
Ergon EY, Acar BH, Celik Kıymet, Colak Ruya et al. (2017). Urinary Tract Infections in Neonates. Тurkish Journal of Pediatric Disease: 1-5. https://doi.org/10.12956/tjpd.2017.288
Gladin DP, Lifanova MV, Lebedeva ND. (2019). The urinary microbiota and severity of infection in children with surgical pathology. Forcipe. 2 (3): 3-13.
Kushnareva MV, Dementyeva GM, Shabelnikova EI et al. (2020). Urinary tract infection in premature newborns. Pediatrician practice. 4: 28-32.
Letifov GM, Kaplieva OV, Burova IJa et al. (2012). The variability of antibioticosensibility of uropatthologens for pyelonephritis in children. Meditsinskij vestnik YUga Rossii: 50.
Lopatkin NA. (2013). Anomalii razvitiya pochek, mochevyih putey i muzhskih polovyih organov. V kn: Urologiya, Moskva «Meditsina»: 147-210.
Malkoch AB, Filatova NN, Dudko MYu et al. (2019). Urinary tract infection in children. Pharmateca. 26 (1): 38-43. https://doi.org/10.18565/pharmateca.2019.1.38-43
Melnikova EA, Luchaninova VN, Krukovich EV et al. (2017). Difficulties and opportunities for diagnosis of urinary tract infection in newborns. Pediatria. 96 (56): 8-14. https://doi.org/10.24110/0031-403X-2017-96-5-8-14
Melnikova EA, Luchaninova VN, Zaytseva EA et al. (2015). The structure and antibiotic resistance of uropatogens of discharges from infants with urinary tract infection. Practical medicine. 2 (87): 97-100.
Melnikova EA, Zaitseva EA, Luchaninova VN et al. (2019). Differentiated approaches to management of urinary tract infections in children taking into account enterococcus faecalis etiology. Pacific Medical Journal. 4 (78): 60-65. https://doi.org/10.34215/1609-1175-2019-4-60-65
Menovshchikova LB, Rudina Yu, Garmanova TN et al. (2015). Clinical guidelines for pediatric urology-andrology. M: Publishing house «Pero»: 240.
Ministry of Health of the Russian Federation. (2018). Urinary tract infections. Clinical guidelines: 24.
Palagin IS, Sukhorukova MV, Dekhnich AV et al. (2019). Anti microbial resistance of pathogens causing community-acquired urinary tract infections in russia: results of multicenter study «DARMIS-2018». Clinical microbiology and antimicrobial chemotherapy. 21 (2): 134-146. https://doi.org/10.36488/cmac.2019.2.134-146
Perepanova TS, Kozlov RS, Rudnov VA et al. (2020). Antimicrobial therapy and prevention of infections of the kidneys, urinary tract and male genital organs. Federal clinical guidelines. Moscow: 72.
Pickard R, Bartoletti R, Bjerklund-Johansen ТЕ et al. (2016). EAU Guidelines on urological infections. European Association of Urology: 16.
Renkema KJ, Winpred PJ, Scovorodkin IN et al. (2011). Nonel Perspectives for undestending congenital anomalies of the kidney and urinary tract (CAKUT). Nephrol Dial Transplant Dec. 26 (14): 3841-3851. https://doi.org/10.1093/ndt/gfr655; PMid:22121240
SRM. (2021). State Register of Medicines. URL: http://www.grls.rosminzdrav.ru.
Stein R, Dogan HS, Hoebeke Р et al. (2015). Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol. 67 (3): 546-558. https://doi.org/10.1016/j.eururo.2014.11.007; PMid:25477258
Sukhorukova MV, Edelstein MV, Skleenova EYu, Ivanchik NV, Shek EA, Dekhnich AV, Kozlov RS, «MARATHON» study group. (2017). Antimicrobial resistance of nosocomial Acinetobacter spp. isolates in Russia: results of multicenter epidemiological study «MARATHON» 2013-2014. Clinical microbiology and antimicrobial chemotherapy. 19 (1): 42-48.
Veshkurtseva IM, Akselrov MA, Yamshchikova EV et al. (2020). Etiological structure and antibiotic resistance of urinary infections pathogens in children. Pediatria n.a. G.N. Speransky. 99 (5): 27-32. https://doi.org/10.24110/0031-403X-2020-99-5-27-32
Vos P, Garrity G, Jones D et al. (2009). Bergeys manual of systematic bacteriology. New York: Springer-Verlag. 3: 1450.
VOZ. (2021). VOZ publikuet spisok bakteriy, dlya borbyi s kotoryimi srochno trebuetsya sozdanie novyih antibiotikov. URL: http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/ru/.
WHO. (2021). World Health Organization. URL: http://www.who.int.
Zakharova IN, Machneva EB, Memladze EB et al. (2017). Diagnosis and treatment of urinary tract infections in children: whats new? Medical advice. 1: 180-185. https://doi.org/10.21518/2079-701X-2017-1-180-185
Zhdanova OA, Gurovich OV, Akhmatova SN et al. (2017). Microflora of urine in urinary tract infections in children of different ages, Applied information aspects of medicine. 20 (3): 89-93.
Downloads
Published
Issue
Section
License
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” 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 “PAEDIATRIC SURGERY.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.
