SOVREMENNAYA PEDIATRIYA.2019.3(99):56-60; doi 10.15574/SP.2019.99.56

Stoieva T. V., Fedin M. V.
Odessa National Medical University, Ukraine

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.

Objective. The purpose of this study was to evaluate the effectiveness of 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.

Materials and methods. The study involved 36 children aged 5 to 15 years with an uncomplicated course of UTI and a frequency of 3 or more episodes per year. Pyelonephritis was diagnosed in 25 children, cystitis in 11 children.

Results. The study found that pathogens of uncomplicated UTI were E. coli, Enterococcus. Proteus. Evaluation of the oral vaccination effectiveness after 6 months showed a decrease of frequency of UTI (before vaccination: 2.94 (95% ДІ 1.89–3.99); after: 0.55 (95% ДІ 0.35–0.75)) and also reduction of urinary syndrome signs (bacteriuria and leukocyturia). Side effects were not registered.

Conclusions. Thus, a multi$component vaccine can be a safe effective alternative in prevention of UTI in children.

Key words: urinary tract infections, children, antibiotic resistance, immunoprophylaxis.

REFERENCES

1. Ahmatova NK, Egorova NB, Kurbatova EA, Ahmatov EA. (2015). Mukozalnyiy immunitet: aktivatsiya agonistami toll-podobnyih retseptorov. Rossiyskiy immunologicheskiy zhurnal. 18;1: 71—82.

2. Zaharova IN, Osmanov IM, Machneva EB, Mumladze EB. (2017). Lechenie i profilaktika infektsiy mochevyih putey u detey: obzor veduschih rekomendatsiy evropeyskih ekspertov. Pediatriya. 1: 10—16.

3. Zorin IV, Vyalkova AA, Gunkova EV, Kutsenko LV. (2019). Profilaktika formirovaniya hronicheskoy bolezni pochek u detey s puzyirno-mochetochnikovyim reflyuksom. Lechaschiy vrach. 1: 40—42.

4. Kirillov VI, Bogdanova NA, Morozov SL. (2018). Neantibakterialnyie alternativnyie meropriyatiya pri infektsii mochevyih putey u detey. Rossiyskiy vestnik perinatologii i pediatrii. 63(1): 106—112.

5. Barclay J, Veeratterapillay R, Harding C. (2017). Non-antibiotic options for recurrent urinary tract infections in women. BMJ: 359. https://doi.org/10.1136/bmj.j5193; PMid:29170359

6. Bitsori M, Maraki S, Galanakis E. (2014). Long-term resistance trends of uropathogens and association with antimicrobial prophylaxis. Pediatr Nephrol. 29(6): 1053—8. https://doi.org/10.1007/s00467-013-2719-x; PMid:24362645

7. Brandstrom P, Hansson S. (2015). Long-term, low-dose prophylaxis against urinary tract infections in young children. Pediatr Nephrol. 30(3): 425—32. https://doi.org/10.1007/s00467-014-2854-z; PMid:24906665

8. Harry LT Mobley, Christopher J Alteri. (2016). Development of a Vaccine against Escherichia coli. Urinary Tract Infections. Pathogens. 5(1): 1. https://doi.org/10.3390/pathogens5010001; PMid:26729174 PMCid:PMC4810122

9. Huttner A, Hatz C, van den Dobbelsteen G. (2017). Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial. Lancet Infect Dis. 17(5): 528—537. https://doi.org/10.1016/S1473-3099(17)30108-1

10. Kishor Tewary, Hassib Narchi. (2015). Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics. World J Methodol. 26; 5(2): 13—19. https://doi.org/10.5662/wjm.v5.i2.13; PMid:26140267 PMCid:PMC4482817

11. Louis M Bell. (2018, Jul). Risks of Prophylaxis to Prevent Recurrent UTIs in Children with Vesicoureteral Reflux. Nejm journal watch pediatrics and adolescent medicine. 142: e20180119.

12. Mattoo TK. (2009). Are prophylactic antibiotics indicated after a urinary tract infection? Curr Opin Pediatr. 21(2): 203—6. https://doi.org/10.1097/MOP.0b013e3283257d0f; PMid:19663037 PMCid:PMC2725357

13. Miroslav Hanus, Michaela Matouskova, Vlasta Kralova еt al. (2015). Immunostimulation with polybacterial lysate (urivac®) in preventing recurrent lower urinary tract infections. Ces Urol. 19(1): 33—43.

14. Pouladfar G, Basiratnia M, Anvarinejad M еt al. (2017). The antibiotic susceptibility patterns of uropathogens among children with urinary tract infection in Shiraz. Medicine (Baltimore). 96(37): e7834. https://doi.org/10.1097/MD.0000000000007834; PMid:28906365 PMCid:PMC5604634

15. Rebecca Forbes, Ased Ali, Alaa Abouhajar еt al. (2018). Alternatives To prophylactic Antibiotics for the treatment of Recurrent urinary tract infection in women (ALTAR): study protocol for a multicentre, pragmatic, patient-randomised, non-inferiority trial. Trials. 19: 616. https://doi.org/10.1186/s13063-018-2998-4; PMid:30413181 PMCid:PMC6230276

16. Taha Neto KA, Nogueira Castilho L, Reis LO. (2016). Oral vaccine (OM-89) in the recurrent urinary tract infection prophylaxis: a realistic systematic review with meta-analysis. Actas Urol Esp. 40(4): 203—8. https://doi.org/10.1016/j.acuroe.2016.02.012

17. Valerie P O'Brien, Thomas J Hannan, Hailyn V Nielsen, Scott J Hultgren. (2016). Drug and Vaccine Development for the Treatment and Prevention of Urinary Tract Infections. Microbiology Spectrum. 4(1): 1. https://doi.org/10.1128/microbiolspec.UTI-0013-2012; PMid:26999391 PMCid:PMC4887100

18. Yunus Yilmaz, Zuhal Tekkanat Tazegun, Emsal Aydin, Mahmut Dulger. (2016). Bacterial uropathogens causing urinary tract infection and their resistance patterns among children in Turkey. Iran Red Crescent Med J. 18(6): e26610. https://doi.org/10.5812/ircmj.26610; PMid:27621929 PMCid:PMC5003060

Article received: Jan 23, 2019. Accepted for publication: Apr 02, 2019.