A ten-year analysis of changes in the sensitivity of the leading uropathogen to antibacterial agents in children with urinary tract infection in the nephrology department.

OBJECTIVE: The aim: To study the prevalence of ABR among children with UTI over the past 10 years, with an assessment of the sensitivity of E. Coli to common antibiotics in dynamics.

PATIENTS AND METHODS: Materials and methods: The study involved 1,044 children with UTI aged from 1 month to 18 years. Examination of patients and interpretation of the results was performed in accordance with the provisions of the Declaration of Helsinki of Human Rights. According to the design, the study included 3 comparison groups: Group 1 - children of the 2009 follow-up year (n = 337), Group 2 - of 2014 (n = 328) and Group 3 - of 2019 (n = 379).

RESULTS: Results: Escherichia coli is recognized as the leading uropathogen in all study groups: its percentage in Group 1 was 47 % (158/337), in Group 2 - 64 % (210/328) and in Group 3 - 66.5 % (252/379). The prevalence of antibacterial resistance of E. coli strains and the high dynamics of its growth are shown. So the level of resistance of E. Coli in 2019 was 70 ± 4.06 % (176/252). This was 11 % more compared to 2014 and 18.8 % more compared to 2009. The percentage of multiresistant strains tended to increase and amounted to 28 ± 9.97 % (70/252) among patients with UTI and 40 ± 9.12 % (70/176) in the structure of resistance in 2019. The relative risk of ABR increased by 1.6 times in 2019 compared to 2014 (RR2019 = 2.208 ± 0.207 [1.473;3.310], р < 0.05 vs RR2014 = 1.375 ± 0.209 [0.913;2.063]) and by 3 times compared to 2009 (RR2009 = 0.727 ± 0.209 [0.483;1.095]). Ampicillin and amoxicillin showed an equally low sensitivity level (3.5 ± 32.14 % (9/252)). Only every second child confirmed sensitivity to cefuroxime (53.6 ± 5.76 (135/252)). Ceftazidime and ciprofloxacin showed a relatively high sensitivity level - 77.4 ± 3.34 (195/252) and 83 ± 2.81 (209/252), and at the same time the rapidly growing resistance rates - almost twice as high over the past 5 years. Furazidin K showed a high sensitivity level of 85.7 ± 2.53% (216/252), the lowest level of overall resistance of 14.3 ± 15.15 % (36/252) and a slow rate of its formation. An unfavourable prognosis of an increase in the relative risk of ABR by 2.9-3.7 times in the next 5-10 years was determined among patients with UTI, provided that the existing diagnostic and treatment approaches are maintained.

CONCLUSION: Conclusions: The study results are important for understanding the clinical decision on the benefits of antibacterial therapy and optimizing its empirical choice for a patient with UTI.