URINE MICROBIAL LANDSCAPE IN CHILDREN WITH URINARY TRACT INFECTIONS IN RYAZAN REGION

Abstract

The aim was to study a spectrum of urine pathogens and their sensitivity to antimicrobial drugs (AMD) in urinary tract infections (UTIs) in children of the Ryazan Region. Study Design: a retrospective study. Patients and Methods. We conducted a retrospective local laboratory monitoring of urinary microflora and analyzed its sensitivity to AMD in 111 patients aged 2 months to 17 years old who were undergoing traditional UTI therapy in the 2020 year. The study group comprised 75 (67.6%) girls and 36 (32.4%) boys. Pathogen isolation and type identification were performed using urine specimens collected in sterile disposable plastic containers prior to antimicrobial therapy. The material was delivered for analysis within 2 hours from collection. For testing pathogen sensitivity to antimicrobials, we used the phenotyping diffusion test and an analytical test for carbapenems inactivation. Study Results. Prevailing causative agents of UIs were Escherichia coli (50.4%) and K. pneumonia (14.4%). Resistance determinants were found in 9.0% and 2.7% of Е. соli and K. pneumonia urological strains, respectively. The main mechanism of resistivity was the production of wide-spectrum plasmid β-lactamases. The highest activity in E. coli was demonstrated by generation III-IV cephalosporins, aminoglycosides, fosfomycin (100%), nitrofurantoin (91.3%), and aminopenicillins (76.1–86.9%). For K. pneumonia, generation III-IV cephalosporins and aminoglycosides were most potent (100%). All resistant pathogens were sensitive to cefoperazone sulbactam, meropenem, imipenem, aminoglycosides (100%); tigecycline, nitrofurantoin, and fosfomycin were most potent against E. coli. Conclusion. Children with UTIs in Ryazan Region had mostly gram-negative bacteria in their urine (85.6%), Enterobacteralеs (81.1%) being a prevailing type. Antimicrobials resistance determinants were quite rare (17.8%) in these urine isolates; all of them were ЕSBL class A producers. These characteristic features of antibiotic resistance of urine pathogenic Enterobacteria strains allow using β-lactam antibiotics in empiric initial treatment and emphasize the need for a patient-specific selection of antimicrobials.