Современные аспекты инфекции мочевой системы у детей — этиология, диагностика, лечение

Abstract

The purpose — to study the microbial spectrum and sensitivity to antibiotics (AB) of acute and recurrent urinary tract infections (rUTI), to evaluate approaches to the diagnosis, treatment and prevention of acute pyelonephritis (AP) in children in comparison with international guidelines. Material and methods. At the initial stage, the microbial landscape of urine and the antimicrobial sensitivity of uropathogens were assessed in 67 children with AP and in 78 patients with rUTI from January 01 to December 31, 2021. Subsequently, clinical, laboratory and instrumental changes, as well as approaches to treatment and prevention were studied in children with AP. Results. The most common etiological uropathogen of AP and rUTI is E. coli — in 82 and 70% of cases, respectively. The share of febrile infection among patients with AP was 77%. 76% of girls with AP had inflammatory changes in the external genital organs according to the gynecological examination. There is an increase in resistance to the main drugs of etiotropic therapy for AP (cefotaxime, ceftriaxone, amoxicillin/clavulanic acid) and anti-relapse prevention (furazidin). The starting AB in the treatment of AP in 97% of cases was administered intravenously, cefotaxime was used more often (91%). Step therapy was used in 77% of patients. Anti-relapse prophylaxis was carried out in 58% of children, and cefuroxime was prescribed for this purpose in 45% of cases. The recurrence rate of urinary tract infection was 4.5%. Conclusions. Given the regular updating of international recommendations for the diagnosis and treatment of urinary tract infections in children, timely revision and adaptation of local protocols to these changes is required.