Gut microbiota and urinary tract infections in children
https://doi.org/10.23946/2500-0764-2021-6-2-24-30
Abstract
Aim. To evaluate the role of intestinal dysbiosis in the development of urinary tract infections in children admitted to a multidisciplinary hospital.
Materials and Methods. We performed a bacteriological analysis of 2,694 urine samples collected from ≤ 3-years-old children who have been admitted to a multidisciplinary hospital (Kemerovo, Russian Federation). Urine specimens were inoculated by the 4-sector technique. Concurrently, we quantified the intestinal microbiota and its antimicrobial resistance in 100 children with urinary tract infections.
Results. Titers of pathogenic microbes significantly differed in patients from distinct units (p = 0.02). The highest number of positive samples was detected in the neonatal pathology and neonatal intensive care units (43.8% each) as well as urology unit (37.9%). The most frequent pathogens belonged to Enterobacteriaceae family, in particular Escherichia coli, Klebsiella spp., Enterobacter spp., and Proteus spp. All studied children (100/100) suffered from intestinal dysbiosis. Titers of Bifidobacterium spp. and Lactobacillus spp. were reduced to 6 (5.0; 8.0) and 5 (4.0; 6.0) lg CFU/g, respectively. In 89.2% children, Escherichia coli lac+ levels were elevated to 9-10 lg CFU/g. Of note, 18.9% children had high Escherichia coli lac- titers [8 (6.0; 9.0) lg] and 24.3% had high Escherichia coli hly+ titers [5 (4.5; 6.0) lg] in the intestine. We have also found a high frequency (44.6%) and density [8.1 (7.0; 8.5) lg] of Klebsiella spp., in the intestinal mucosa of such patients. Notably, Enterobacter spp. and Proteus spp. were abundant [7 (5.0; 8.0) CFU/g] in the intestinal microbiota of 10.8% children. The prevalence of resistance strains in the studied setting reached 63%.
Conclusions. More than 75% children with urinary tract infections suffer from intestinal dysbiosis. The microbiome of these patients was predominantly composed of Enterobacteriaceae and was characterized by high titers of Escherichia coli lac+, Klebsiella spp., Enterobacte spp., and Proteus spp. Similar profile of antimicrobial resistance in urinary and intestinal isolates of enterobacteria suggests intestinal microbiome as the main source of pathogens causing urinary tract infections in children.
About the Authors
L. A. Levanova
Kemerovo State Medical University
Russian Federation
Russian Federation
MD, DSc, Professor, Head of the Department of Microbiology, Immunology and Virology,
22a, Voroshilova Street, Kemerovo, 650056
A. A. Markovskaya
Kemerovo State Medical University
Russian Federation
Russian Federation
Assistant Professor, Department of Epidemiology, Infectious Diseases, Skin Disorders and Sexually
Transmitted Diseases,
22a, Voroshilova Street, Kemerovo, 650056
L. Yu. Otdushkina
Kemerovo State Medical University
Russian Federation
Russian Federation
MD, Assistant Professor, Department of Microbiology, Immunology and Virology,
22a, Voroshilova Street, Kemerovo, 650056
Yu. V. Zakharova
Kemerovo State Medical University
Russian Federation
Russian Federation
MD, DSc, Associate Professor, Department of Microbiology, Immunology and Virology,
22a, Voroshilova Street, Kemerovo, 650056
References
1. Vyalkova AA, Gritsenko VA. Modern approaches to the diagnosis and treatment of renal disease in children. Nephrology (Saint-Petersburg). 2018;22(3):72-87. (In Russ.). https://doi.org/10.24884/1561-6274- 2018-22-3-72-87
2. Kushnareva MV, Dement'eva GM, Shabel'nikova EI, Balashova ED, Gerasimov AYu, Markhuliya KhM. Infektsii mochevyvodyashchikh putey u nedonoshennykh novorozhdennykh. Praktika pediatra. 2020;(4):28-31. (In Russ.).
3. Tullus K, Shaikh N. Urinary tract infections in children. Lancet. 2020;395(10237):1659-1668. https://doi.org/10.1016/S0140-6736(20)30676-0
4. Kulchavenya EV. A new approach to understanding the pathogenesis and treatment of infectious and inflammatory diseases of the urogenital tract. Urologiia. 2020;(5):99-105. (In Russ.). https://doi.org/10.18565/urology.2020.5.99-105
5. Illek YY, Razin MP, Vaganova EA. The state of immunological reactivity of children with acute pyelonephritis in different periods of disease. Medical newsletter of Vyatka. 2005;(3-4):8-11. (In Russ.).
6. Bukharin OV, Perunova NB. The role of microbiota in the regulation of homeostasis in the human body during infection. Journal of microbiology epidemiology immunobiology. 2020;5(97):456-46. (In Russ.). https://doi.org/10.36233/0372-9311-2020-97-5-8
7. Stewardson AJ, Vervoort J, Adriaenssens N, Coenen S, Godycki-Cwirko M, Kowalczyk A, Huttner BD, Lammens C, Malhotra-Kumar S, Goossens H, Harbarth S; SATURN WP1 Study Group; SATURN WP3 Study Group. Effect of outpatient antibiotics for urinary tract infections on antimicrobial resistance among commensal Enterobacteriaceae: a multinational prospective cohort study. Clin Microbiol Infect. 2018;24(9):972-979. https://doi.org/10.1016/j.cmi.2017.12.026
8. Xu JY, Liu MT, Tao T, Zhu X, Fei FQ. The role of gut microbiota in tumorigenesis and treatment. Biomed Pharmacother. 2021;138:111444. https://doi.org/10.1016/j.biopha.2021.111444
9. Wang L, Zhou W, Guo M, Hua Y, Zhou B, Li X, Zhang X, Dong J, Yang X, Wang Y, Wu Y, She J, Mu J. The gut microbiota is associated with clinical response to statin treatment in patients with coronary artery disease. Atherosclerosis. 2021;325:16-23. https://doi.org/10.1016/j.atherosclerosis.2021.03.007
10. Kuz'menko SA, Brusina EB. Meditsinskie tekhnologii, vliyayushchie na infitsirovanie detey bakteriyami roda Klebsiella, profilaktika infitsirovaniya. Chronos. 2020;8(46):39-43. (In Russ.).
11. Kotelevetc EP. Monitoring of species composition and antibiotic resistance of uroinfection pathogens. Universitetskaya klinika. 2020;2(35):20-24. (In Russ.). https://doi.org/10.26435/UC.V0I2(35).451
12. Omarova SM, Mallaeva AM. Rol' uslovno-patogennykh bakteriy v razvitii vnutribol'nichnykh infektsiy mochevyvodyashchikh putey. Evraziyskiy soyuz uchenykh. 2014;6-4(6):49-50.
13. Ohnishi T, Mishima Y, Matsuda N, Sato D, Umino D, Yonezawa R, Kinoshita K, Tamura K, Mimura S, Ariji S, Maeda N, Ozaki K, Fukushima H, Arakuma T, Tsuchida S, Nishimoto H, Araki Y, Yoshida M, Tamame T, Suzuki S, Sekijima T, Kowase T, Takahashi K, Kamimaki I. Clinical characteristics of pediatric febrile urinary tract infection in Japan. Int J Infect Dis. 2021;104:97-101. https://doi.org/10.1016/j.ijid.2020.12.066
14. Simões E Silva AC, Oliveira EA, Mak RH. Urinary tract infection in pediatrics: an overview. J Pediatr (Rio J). 2020;96 Suppl 1:65-79. https://doi.org/10.1016/j.jped.2019.10.006
Review
For citations:
Levanova L.A., Markovskaya A.A., Otdushkina L.Yu., Zakharova Yu.V. Gut microbiota and urinary tract infections in children. Fundamental and Clinical Medicine. 2021;6(2):24-30. (In Russ.) https://doi.org/10.23946/2500-0764-2021-6-2-24-30
Views:
557
Email this article 