Features of Antibiotic Resistance in Uncomplicated Urinary Tract Infection in Children and Effectiveness of Immunoprophylaxis

Abstract

Background: The relapsing course of urinary tract infections (UTI) is an important issue. Repeated courses of antibiotics contribute to selection of multi-resistant microorganisms. Obviously, a new way of prevention, such as vaccination, has to be introduced. Objectives: The purpose of this study was to evaluate the effectiveness of oral vaccination with a complex of frozen lyophilized microorganisms — Escherichia coli, Enterococcus faecalis, Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Propionibacterium acnes for the prevention of recurrent UTI in children. Methods: The study involved 30 children aged 7 to 16 years with an uncomplicated course of UTI and a frequency of 3 or more episodes per year. The study found that pathogens of uncomplicated UTI were E. coli (66.7%), Enterobacter aer., Enterococcus faecalis, Enterococcus spp., Proteus mirabilis, Proteus vulgaris, S. hominis, Streptococcus haemolyticus. Several pathogens were observed in 10% of patients, the presence of polymycrobial microflora correlated with the frequency of UTI (χ2 = 3.84, p<0.05). The resistance of microflora to antibiotics decreased in the following order: aminoglycosides (4%), carbapenems (9%), cephalosporins (9%), fluoroquinolones (13%), protected penicillins (17%), macrolides (22%), penicillins (26%). Results: Evaluation of the oral vaccination effectiveness after 6 months showed a decrease of UTI rate (before vaccination: 3.55 (95% CI 2.91–4.18); after: 0.93 (95% 0.57–1.29) and also reduction of urinary syndrome signs (bacteriuria and leukocyturia). Side effects were not registered and 2/3 patients showed an improvement of their condition. Conclusion: So, a multi-component vaccine can be a safe, effective alternative in prevention of UTI in children.