REGIONAL ANTIBIOTIC RESISTANCE OF UROPATHOGENS IN THE PEDIATRIC POPULATION OF NORTHERN BUKOVINA

Abstract

In the current context of medical practice for rational antibiotic therapy, it is necessary to take into account possible over time changes in the sensitivity of pathogens, in particular uropathogens. The identification of regional characteristics of the antibiotic resistance of the urinary tract infections (UTIs) enables improvement of treatment outcomes regarding the patients with this pathology.The aim of the work is to study regional characteristics of the antibiotic resistance of the of urinary tract infection pathogens (UTIs) in the pediatric population of Chernivtsi region.Materials and methods of investigation. The antibacterial resistance of uropathogens, identified in 657 urine samples of patients who received specialized medical care in the Nephrology department of the MMI City Children’s Clinical Hospital of Chernivtsi (2014-2016), was analyzed. The controlled group of the examined children (n = 482) included patients with UTI. The experimental group (n = 175) consisted of patients with non-infectious diseases of the genitourinary system.Research results. In Chernivtsi oblast among the children with the genitourinary infections of infectious-inflammatory and non-infectious genesis, there are significant differences in the etiological structure of the selected uropathogens, for instance, in the isolated gram-positive cocci (E.faecalis, S.aureus, S.viridans, p <0.05), enterobacteria (E. coli, P. mirabilis P. rettgeri P. vulgaris, p <0.01), and the resident flora (Bacillus spp., Corynebacterium spp., Lactobacillus spp., Micrococcus spp, S. saprophyticus, S. epidermidis, p < 0, 01). In patients with UTI, the leading uropathogens are strains of theEnterobacteriaceae family; among the children of this region with UTI, an undulating curve in the dynamics of the antibiotic resistance of the uropathogens of the Enterobacteriaceae family with a tendency to reduce towards «choice of drugs» was observed: semi-synthetic penicillins (amoxicillin / clavulanate– 2 = 7.694, p <0.01), II-III generation cephalosporins (cefuroxime –c2 = 4.807, p <0.01, ceftazidime–c2 = 15.077744, p <0.01; ceftriaxone – 2 = 5.633, p <0.01; cefepime–c2 = 12.971, p < 0,01; cefoxytin–c2 = 20,940; p <0,01) and preparations of fluoroquinolone series (ofloxacin–c2 = 6,023, p <0,01; ciprofloxacin –c2 = 5,876; p <0,01; levofloxacin –c2 = 4.338, p<0.01).Conclusion. There is an undulating curve in the dynamics of the antibiotic resistance of uropathogens of theEnterobacteriaceae family with a tendency towards of choice reduction observed in pediatric patients with UTI living in Chernivtsi region: semi-synthetic penicillins (p <0.01), II-III generation cephalosporins ( р <0,01), and preparations of fluoroquinolone series (р <0,01) requiring revision of the therapeutic regimens of UTI treatment taking into account the received data in accordance with the Order of the Ministry of Health of Ukraine №627 dated November 3, 2008. On Approval of the Protocols for the Provision of Medical Aid to Children in the Specialty PediatricNephrology will allow improving the treatment outcomes of the pediatric population at the regional level for the account of a differentiated approach to the empirical use of antibacterial drugs for the pathogenetic treatment of patients with UTI, primarily in the pre-admission phase.