Features of Antibiotic Resistance in Uncomplicated Urinary Tract Infection in Children and Effectiveness of Immunoprophylaxis

Abstract

The relapsing course of urinary tract infections (UTI) is an important issue. Repeated courses of antibiotics contribute to selection of multi-resistant microorganisms. Obviously, a new way of prevention, such as vaccination, has to be introduced. Objectives: The purpose of this study was to evaluate the effectiveness of oral vaccination with a complex of frozen lyophilized microorganisms – Escherichia coli, Enterococcus faecalis, Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Propionibacterium acnes for the prevention of recurrent UTI in children. Methods: The study involved 30 children aged 7 to 16 years with an uncomplicated course of UTI and a frequency of 3 or more episodes per year. The study found that pathogens of uncomplicated UTI were E. coli (66.7%), Enterobacter aer., Enterococcus faecalis, Enterococcus spp., Proteus mirabilis, Proteus vulgaris, S. hominis, Streptococcus haemolyticus. Several pathogens were observed in 10% of patients, the presence of polymycrobial microflora correlated with the frequency of UTI (χ2 = 3.84, p<0.05). The resistance of microflora to antibiotics decreased in the following order: aminoglycosides (4%), carbapenems (9%), cephalosporins (9%), fluoroquinolones (13%), protected penicillins (17%), macrolides (22%), penicillins (26%). Results: Evaluation of the oral vaccination effectiveness after 6 months showed a decrease of UTI rate (before vaccination: 3.55 (95% CI 2.91–4.18); after: 0.93 (95% 0.57–1.29) and also reduction of urinary syndrome signs (bacteriuria and leukocyturia). Side effects were not registered and 2/3 patients showed an improvement of their condition. Conclusion: So, a multi-component vaccine can be a safe, effective alternative in prevention of UTI in children.