Epidemiology of antibacterial resistance in children with urinary tract infection: dynamics for 2009 2019 and its impact on the disease course
Keywords:
urinary tract infection, children, Escherichia coli, antibacterial resistanceAbstract
The rapid rate of antibiotic resistance (ABR) among children with urinary tract infection (UTI) dictates the need for a comprehensive study of its prevalence, nature, the prognosis for understanding management mechanisms.The aim. Study of the epidemiology of ABR in hospitalized children and adolescents with UTI, evaluation of the rate of selection of resistant E. coli strains over the past 10 years and the impact of ABR on the disease course.
Materials and methods. The prevalence of resistant E. coli (ABR) strains depending on age and gender was studied in a total cohort of patients with UTI (n=2754) aged 1 month. up to 18 years for the period 2009–2019. The dynamics and rates of E. Coli ABR development were investigated in 3 comparison groups: group I — children in 2009 (n=337), group II — 2014 (n=328), III group — 2019 (n=379).
Results. The prevalence of ABR in children with UTI is shown: every two children had resistance (57.6%±1.6 (1586/2754)) and every 3–4 children had polyresistance (27.4%±3.04 (755/2754)). Resistant uropathogenic strains are more commonly reported in children aged 1–3 years and 4–6 years, both among boys (25/95 (26±16.91) vs 27/95 (28±16.04)), and among girls (417/1491 (28±4.07) vs 477/1491 (32±3.7)). Under the age of 1 year, boys (more often than girls) had resistance (8/95 (9±33.33) vs 75/1491 (5±11.03), p=0.039) and polyresistance (3/53 (5±55.48) vs 14/702 (2±25.95), p=0.034). The statistically significant advantages of polyresistance in boys aged 7–12 years (17/53 (33±19.78) vs 154/702 (22±6.98), p=0,021) and in girls aged 1–3 years (175/702 (25±6.42) vs 8/53 (16±32.23), p=0.04). Resistance among E. coli strains has increased by 11% over the past 5 years and by 19% over 10 years, reaching 70%±4.06 (176/252) in 2019. The proportion of E. coli polyresistant strains among patients with resistance in 2019 was 40%±9.12 (70/176). The mathematical prediction of the prevalence of resistant E. coli strains after 15 years approached 100% (y=9.5×6+41=98%) at R2=0.9918. After 10 years, the indicator corresponded to 88.5%, and after 5 years — 79%. The relative risk of reinfection (RR) in patients in 2019 had statistically significant benefits compared to even the last 5 years (RR2014=1.130±0,224 [0.728; 1.753] vs RR2019=1.496±0,195 [1.021; 2.191], p<0.05). A high Pearson correlation was found between high-strength correlation between E. coli resistance and reinfection in children (ρ=0.975, p<0.05).
Conclusions. The results of the study revealed the prevalence of ABR among children with UTI over the past 10 years, determined the pace and prognosis of its development, emphasized the impact on the formation of recurrent course of this pathology.
Patient screening and interpretation of the results were conducted within the framework of the Helsinki Declaration.Автор заявляет об отсутствии конфликта интересов.
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