Regional monitoring of the urinary tract infections causative agents antibiotic resistance in the child population of the Chernivtsi region

Materials and methods. The analysis of etiologic spectrum and antibiotic resistance of uropathogens was conducted and observed 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) with the purpose of the dynamic control of possible changes in the regional antibiotic resistance of pathogens of causative pathogens of the “urinary tract infections” (UTI); identify the age and gender differences of the child population of the Chernivtsi region (2014–2015) compared to the monitoring data for the period of 2009–2013.


Purpose
The aim of the article is to determine the range and dynamics of the antibiotic resistance of majority groups of infectious-inflammatory diseases causative agents of the urinary tract in the child population of the Chernivtsi region.

Materials and мethods
The analysis of etiologic spectrum and antibiotic resistance of uropathogens was conducted and observed in the urine samples of 657 patients provided with a specialized medical care in the Nephrology department at the "Municipal Children's Clinical Hospital", Chernivtsi (2014-2015) (Table 1).
The main group has comprised patients having been diagnosed with infectious-inflammatory diseases of the urinary tract according to the МКХ-10 № 10-11.1 Renal infections.The comparison group has included the patients with non infectious-inflammatory diseases of the urinary tract with nosological code according to МКХ-10: N00 acute nephrotic syndrome; № 03 chronic nephrotic syndrome; № 04 nephrotic syndrome; № 15 Other renal tubulointerstitial diseases; № 18 Chronic kidney insufficiency; № 39 Other disorders of the urinary system; № 39.2 Orthostatic proteinuria, unspecified; R30 Pain in urination; R30.1 Vesical tenesmus; R32 Urinary incontinence, unspecified.
It should be mentioned that for statistical handling and subsequent analysis of the gained data, only the results of the initial examination in both groups have been selected: the main group -330 children (68.46 % of the examined patients) and the comparison groups 115 children (65.71 % of the examined patients).
The bacteriological research of the urine samples have been provided on the basis of microbiological research sector of the medico-ecological problems (Chernivtsi) of "L.I. Medved's Research Center of Preventive Toxicology, Food and Chemical Safety, Ministry of Health, Ukraine (State Enterprise)", Kyiv; family and genus identification of the isolated strains have been conducted applying conventional methods of microbiology.The strains with their exceeded amount in 1 ml of urine or with their amount near to 1×103 of colony forming units (CFU) in a case of enterobacteria-isolation were considered to be significant ones.During the pseudomonads isolation, Staphylococcus aureus, the yeast-like fungi were associated with etiologically significant ones, whereas their amount to be at least 1×102 CFU in 1 ml of urine.The detection of bacterial strains antibiotic sensibility was conducted according to the order of the Ministry of Health of Ukraine № 167 from 05. 04.2007."On the approval of guidelines to determine the sensitivity of microorganisms to antibiotics".
The objective aims at the dynamic control of possible changes in the regional antibiotic resistance of causative pathogens of the "urinary tract infections" (UTI); as well as to identify the age and gender differences of the child population in the Chernivtsi region (2014-2015) compared to the monitoring data for the period of 2009-2013 years [1][2][3].
Statistical handling of the results -evaluation of the percentage data computed with Fisher angle transformation.Percentage differences in the group were evaluated with Chi-square (c 2 ) Pearson criteria [7].
The monitoring results for the period of 2009-2013 years [1][2][3] and obtained data of 2014-2015 observation years state that strains of the family Enterobacteriaceae (excluded Proteus) prevail in microbial "landscape" in the child urine of the region; at the same time, it is worth to draw the attention to differences considering antibiotic sensitivity in UTI and non-infectious diseases of the urinary tract (Fig. 1).
Enterobacteriaceae strains (excluded Proteus) isolated from the urine of the patients with non-infectious pathology of the urinary tract (comparison group), basically, were more resistant to all used in the research, β-lactam antibiotics and aminoglycoside in comparison with the strains isolated from the urine of children with UTI (the main group).At the same time a decreasing sensitivity to the strains of the family Enterobacteriaceae (excluded Proteus) to the medications of the fluoroquinolone class is preserved among the children with UTI (2014-2015 years), which has been fixed in 2009-2013 years of observation [2,3] in comparison with enterobacteria strains isolated from the urine of the patients with non-infectious diseases of urinary tract.
The monitoring results ( of 2009-2015 years) state, that among the child population of Chernivtsi region in UTI a "wave-like" curve of the dynamics of antibiotic resistance of uropathogens of the family Enterobacteriaceae with a decreasing tendency to the "drugs of choice" was observed: penicillins (P < 0.01), cephalosporins II-III generation (P < 0.01) and medications of the fluoroquinolone class (P < 0.01); and antibiotic resistance of Proteus uropathogens -to semi-synthetic penicillins (P < 0.1), and medications of the tetracycline class (P < 0.01) (Tables 2-3).

Cont. Table 2
Original research

Cont. Table 2
Conclusions 1.In UTI among of the child population of the Chernivtsi region leading etiologic causative agents are observed to be strains of the family Enterobacteriaceae and uropathogenic of the genus Proteus.
2. A "wave-like" curve of the dynamics of antibiotic resistance of Enterobacteriaceae uropathogens with a decreasing tendency to the "drugs of choice" was observed among the child population of the region (of 2009-2015 years): penicillins (P < 0.01), cephalosporins II-III generation (P < 0.01) and medications of the fluoroquinolone class (P < 0.01).A "wave-like" curve of the dynamics of antibiotic resistance of Proteus uropathogens with a decreasing tendency to the "drugs of choice" was observed among the child population of the region (of 2009-2015 years): semi-synthetic penicillins (P < 0.1), and medications of the tetracycline class (P < 0.01).
3. Regional microbiological monitoring of the uropathogens is an effective "tool" in treatment efficiency enhancement of infectious and inflammatory diseases of the urinary tract among the child population.
Prospects of the future research directed towards dynamic control of the regional monitoring among the child population in Chernivtsi region.

Fig. 1 . 1 :
Fig. 1.Antibiotic resistance of the causative pathogens strains of the family Enterobacteriaceae (excluded Proteus) was isolated in the examined patients during the 2014-2015 years.1: infectious-inflammatory diseases of the urinary tract; 2: non-infectious diseases of the urinary tract.

Table 1 .
Age and gender distribution of the examined children in Chernivtsi region with urinary tract diseases

Table 2 .
Dynamics of the antibiotic resistance of the family Enerobacteriaceae uropathogens (excluded Proteus) as an etiological cause of the infectious-inflammatory diseases of the urinary tract in children of Chernivtsi region

Table 3 .
Dynamics of the antibiotic resistance of the genus Proteus, as an etiological cause of the infectious-inflammatory diseases of the urinary tract in children of Chernivtsi region