Regional monitoring of the urinary tract infections etiological spectrum pathogens in the child population in Chernivtsi region : dynamic changes , age , gender , administrative and territorial characteristics

Materials and methods. The etiologic spectrum of uropathogens identified in the urine samples of 657 patients who were provided with a specialized medical care in the Nephrology Department of the “Municipal Children’s Clinical Hospital”, Chernivtsi (2014–2015) was analyzed in order to dynamically control the possible changes of the “urinary tract infections” (UTI) regional etiological structure and antibiotic resistance of pathogens; identification of age and gender differences of urine microbial diversity in the child population in Chernivtsi region (2014–2015) compared with the monitoring data for the 2009–2013 period.


Introduction
Infections of the urinary system (UTI) among children are a global medical and social problem; data of etiologic spectrum of children's uropathogens in Ukraine differ, and it shows a need to study their regional characteristics [1][2][3][4][5].

Purpose
The aim of the article is to determine the range of etiological spectrum groups of the urinary tract infectious-inflammatory diseases causative agents in the child population in Chernivtsi region.
The comparison group (n = 175) included patients with non-infectious diseases of the urinary system with nosology code according to ICD-10: N00 Acute nephrotic syndrome; № 03 Chronic nephrotic syndrome; № 04 Nephrotic syndrome; № 15 Other kidney tubulo-interstitial diseases; № 18 Chronic kidney failure; № 39 Other disorders of the urinary system; № 39.2 Orthostatic proteinuria which is not specified; R30 Pain associated with urination; R30.1 Tenesmus of the urinary bladder; R32 Urinary incontinence which is not specified.
It should be noted that the results of both groups primary examination were selected for statistical analysis and further analysis of the data (Тable 1).
Bacteriological investigation of urine samples was made at the State Establishment "L.I. Medved's Research Center of Preventive Toxicology, Food and Chemical Safety, Ministry of Health of Ukraine", Kyiv.Gender and specific identification of selected pathogens was generally carried out using clinical microbiology methods.It has been found that etiologically significant pathogens were such pathogens amount of which in 1 ml of urine was higher or close to Оригинальные исследования 1×10 3 of colony-forming units in the case of enterobacteria excretion.They were put to etiology significant units during the excretion of pseudomonas, staphylococcus aureus and fungi yeast if their number in 1 ml of urine was less than 1×10 2 of colony-forming units.Pathogens' antibiotic susceptibility was determined according to the order of Ministry of Health of Ukraine № 167 from the 5 th of April, 2007 "On approving the methodological guidelines "Determination of the sensitivity of microorganisms to antibiotics"".
With the purpose of the dynamic control of possible changes in the regional etiological structure and antibiotic resistance of pathogens that cause the "urinary tract infections" (UTI); the age and gender differences of urine microbial diversity in the child population in Chernivtsi region (2014-2015) compared with the monitoring data for the 2009-2013 period were identified.
Statistical analysis of the results -an assessment of the results using the Fisher's angular transformation method; difference in frequency among the groups was assessed using the Pearson square calculation method (c 2 ) [6].
The percentage of etiologically significant microorganisms detection from urine of patients with UTI was similar in both sexes of the examined children, only teenage girls were marked with growing of this indicator, it was higher than at boys more than 3 times.
The analysis of uropatogens etiologic spectrum has shown significant differences in the microbial diversity of both examined groups urine -the main group and the group of comparison (Table 2).
The analysis of nosological forms microbial diversity hasn't revealed significant differences in the structure of detected strains in the main group of examined patients with UTI (Fig. 2) Administrative and territorial differences in etiological structure of urine microbial diversity in pediatric patients have been registered -residents of urban areas (p < 0.01) from their rural areas peers (Table 3).
The regional monitoring data showed that the observation

Original research
of children (0-18 years old) in Chernivtsi region with infectiousinflammatory diseases of the urinary tract during 2009-2015 had been characterized by a change in the resident microflora of the urine (p < 0.01) without significant changes of the UTI strains etiological spectrum.At the same time a significant increase in the proportion of "negative results" (no growth) in the urine bacteriological analysis (p < 0.01) was traced, which might indirectly indicate the "uncontrolled" use of antibiotics among children in the area (Fig. 3).

Conclusions
1.During the urinary tract infections among child population in Chernivtsi region the leading etiological causative agent was the strain of Enterobacteriaceae family (except Proteus mirabilis).A significant difference has been found in the etiological structure of microbial diversity in children's with infectious and in-flammatory diseases of the urinary tract urine (Gram-positive cocci -p < 0.05; enterobacteria -p < 0.01; resident microflora -p < 0.01) in comparison with ex-tracted uropathogens in urinary tract noninfectious diseases in children of the region.
2. The percentage of urine etiology meaningful microflora excretion in pa-tients with UTI was generally similar in children of both sexes, except for adoles-cent girls -the frequency of uropatogens excretion was 3 times more (p < 0.05) compared to peers.
3. Administrative and territorial differences have been registered in etiolog-ical structure of the urine microbial diversity in children living in the urban areas (p < 0.01) from their peers living in the rural areas The perspectives of further scientific research are the dynamics of uropatogens antibiotic resistance analysis among pediatric patients in Chernivtsi region; dynamic control of regional microbiological monitoring among child population in this region.

Fig. 1 .
Fig.1.Etiological diversity of strains (%) which were taken from the examined patients (1 -infectious-inflammatory diseases of the urinary system; 2 -non-infectious diseases of the urinary system).

Fig. 2 .Fig. 3 .
Fig. 2. Microbial diversity of urine in the examined patients with infectious-inflammatory diseases of the urinary system.

Table 1 .
Distribution of primary examined children with urinary system diseases

Table 2 .
Structure of uropatogens etiological spectrum in the examined patients with the urinary system diseases

Table 3 .
Administrative-territorial differences in the etiological structure of uropatogens among the examined children with diseases of the urinary system