| کلیدواژههای انگلیسی مقاله |
Urinary tract infections, Urination disorders, Anti-bacterial agents, Microbiology, Infection control, What&,rsquo s Known Urinary tract infections are among the most common and serious diseases in children, leading to frequent relapses and potentially serious complications and requiring significant treatment costs. The prevalence of uropathogens and antibiotic resistance varies by region and medical institution, influenced by local factors, including antibiotic usage, epidemiology, and patient characteristics. What&,rsquo s New The novelty of this study lies in its geographic, population and demographic specificity, allowing to take into account local features of the prevalence of uropathogens and their resistance, which have not been sufficiently studied in this region before. The study allows optimizing the choice of antibacterial drugs, creating a theoretical database and clinical recommendations that will reduce the risks of global antibiotic resistance. The dominant uropathogens isolated in the study were Escherichia coli, Enterococcus faecalis, and Staphylococcus epidermidis. Antibiotic resistance was found to increase almost twofold with age, with higher rates of resistance observed in boys compared to girls. IntroductionUrinary tract infections (UTIs) are the most common and serious infections in children. Every year, more than one million children with UTIs visit a doctor, and 500,000 children are transported to hospitals by emergency services. 1, Moreover, 30-50% of children with a UTI have subsequent relapses. 2, The primary incidence of UTI in children under 5 years of age in Kazakhstan was 1333.7 per 100,000 children in 2017. 3, These infections can lead to significant complications, such as chronic kidney disease and arterial hypertension, 4, which incur significant financial costs for subsequent treatment. For example, treatment for UTIs is valued at USD 9.2 billion in 2022 and will rise to USD 11.9 billion by 2032. 5, UTIs are characterized by a high recurrence rate 6, and are associated with anatomical and functional abnormalities of the urinary system. 7, The peak of relapse occurs at the age of 2&,ndash 4 years. During the first year of life, the incidence of UTI was higher in boys than in girls. After one year, the probability of developing UTI in girls increased by 10-12 times. 8, A study conducted at the French Medical Institute for Children in 2018 found that the dominant pathogens of urinary tract infections were Escherichia coli (63.9%), Enterococcus (11.1%), Serratia (10.8%), Staphylococcus (8.2%). 9, Although Staphylococcus epidermidis was previously considered a contaminant in urine tests, the literature suggests that it can cause UTIs. 10, Moreover, when the frequency of certain types of staphylococci changes, the proportion of S. epidermidis and Staphylococcus haemolyticus increases, which can act as pathogens, especially in the presence of local immunodeficiency. 11, The most common pathogen of UTI is E. coli, 12, among other Gram-negative bacteria are Proteus mirabilis and Proteus vulgaris. 13, Moreover, UTI caused by E. coli are lower in neonates. 14, In children with urinary tract abnormalities or a weakened immune system, S. aureus, S. epidermidis, Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus viridians, and Streptococcus agalactiae are the common causes of UTI. 10, Studies show that treatment of UTIs is becoming increasingly difficult due to increasing antibiotic resistance among uropathogens, especially E. coli, which is associated with widespread antibiotic use (25-40%). 15, Resistance patterns vary by region, resistance of E. coli to co-amoxiclav increased by 13.7% in Ireland (2016-2021), 16, Extended&,ndash Spectrum Beta-Lactamase positive E. coli increased from 6.1% to 25.4% in Israel (2007-2021), 17, and increased resistance to major antibiotic classes was observed in the European Economic Area from 2013 to 2016. 18, The rise in antimicrobial resistance in children is a global issue requiring localized responses due to regional variability. While multicenter studies in Kazakhstan have focused on community-acquired infections across all ages, showing sensitivity data only for E. coli, 19, our study specifically addresses the etiological structure and resistance in pediatric UTIs, including children under 1 year, a group often overlooked in previous research, 20, especially in industrial regions where data remain limited.This study aimed to investigate the microbial spectrum and resistance profile of uropathogens among patients at the Regional Children&,rsquo s Clinical Hospital of Karaganda, Kazakhstan, to identify patterns of resistance to antibacterial drugs and develop recommendations for preventing the spread of resistant strains.Materials and MethodsThis study was performed in accordance with the principles of the Declaration of Helsinki (1978). The study protocol was approved by the local ethical committee of the Faculty of Natural Sciences of the L. N. Gumilyov Eurasian National University (No. 7 dated March 24, 2021). Informed consent was obtained from the parents or legal guardians.This retrospective cohort study was conducted at the Regional Children&,rsquo s Clinical Hospital of Karaganda over 6 years, from January 2017 to December 2022. Analysis was carried out on the medical records (the date of sample collection, sex and age of patients, bacterial isolates, and antibiotics prescribed) of 762 children aged 0 to 60 months. The inclusion criteria included all children born and living since birth in a given city with a diagnosis of UTI, while the exclusion criteria excluded patients with incomplete data or chronic diseases. The subjects were divided into two age groups, Group I (0-12 months) and Group II (13-60 months) on the basis of anatomical and physiological characteristics.This study examined the clinical and laboratory characteristics of patients with positive urine cultures showing &,ge 105 colony-forming units per milliliter (CFU/mL) using midstream or catheterized samples collected before antibiotic therapy and analyzed using the VITEK2 Compact system (BioM&,eacute rieux SA, France) at the GIO TRADE laboratory (Karaganda, Kazakhstan). Antibiotic sensitivity was determined using the Kirby-Bauer test (Nutrient medium produced by the State Research Center for Applied Microbiology and Biotechnology, Russia). Antibiogram results categorized the isolates as susceptible or resistant. Standardized reference strains provided by organizations such as American Type Culture Collection (ATCC), Collection of Institute Pasteur (CIP), German Collection of Microorganisms and Cell Culture (DSM), National Collection of Type Cultures (NCTC), Culture Collection University of Gothenburg (CCUG), Spanish Type Culture Collection (CECT), and other national collections (E. coli ATCC 25922, E. coli CIP 7624, E. coli DSM 1103, E. coli NCTC 11954, E. coli CCUG 30600, E. coli CECT 943, and others) were used to calibrate and verify the performance of VITEK 2 Compact. Quality control included both internal control (checking test results using control cartridges) and external control (participation in external quality control programs, such as interlaboratory comparison programs provided by the College of American Pathologist and Clinical and Laboratory Standards Institute) to evaluate its performance. Analyses were performed by two bacteriology doctors and three laboratory assistants.Karaganda is a large industrial center where large deposits of coal, lead, zinc, iron, manganese, and rare metals are concentrated. The city ranks 23rd among the countries in the world with the most polluted air. 21, Karaganda is an economically developed region of Kazakhstan, with an unemployment rate of 4.2%. 22, Statistical Analysis Data were collected and analyzed using Microsoft Excel 2007 (Microsoft Corporation, USA) and RStudio (Posit PBC, USA). Quantitative variables were described as mean and standard deviation using the t test and Chi square test to analyze differences and relationships at a significance level of 0.05.ResultsIn total, 762 patients aged 0&,ndash 60 months were hospitalized for UTI. The patients included Kazakhs (65.3%), Russians (12.3%), Ukrainians (9.4%), Jews (3.7%), Germans (3.1%), Tatars (2.5%), Koreans (1.9%), Chechens (1%), and others (Belarusians, Uzbeks, Azerbaijanis, Romanians, Georgians-0.8%). The number of isolated uropathogens was 519 (68.1%), of which 313 (60.3%) were detected in girls and 206 (39.7%) in boys with a first episode of UTI. By age, the number of isolated uropathogens was distributed as follows, 286 (55.1%) from to 0-12 months and 233 (44.9%) from to 13-60 months. The most common pathogens were E. &,#1089 oli, E. faecalis, and S. epidermidis.With age, the role of E. coli increased, accounting for 37.1% of all uropathogens by 13-60 months, and the role of E. faecalis and S. epidermidis decreased from 18.6% to 11.3% and from 9.3% to 8.3%, respectively. Age-related increases were also observed in Pseudomonas aeruginosa (7.3 times) and P. mirabilis (4.3 times). A decrease in the incidence of Enterobacter cloacae and Enterococcus faecium, by five times and 2.3 times, respectively, was also noted. S. &,#1072 ureus and Staphylococcus gallinarium were mainly found in children under one year, whereas Klebsiella pneumoniae, S. viridans, and Hafnia alvei were more common in children over one year of age (table 1,).PathogenGroup I (0-12 months)Group II (13-60 months)TotalP valuesN (%)N (%)N (%)Escherichia coli85 (29.3)85 (37.1)*170 (32.7)0.05Enterococcus faecalis54 (18.6)*26 (11.3)80 (15.4)0.02Enterococcus faecium17 (5.9)6 (2.6)23 (4.4)0.16Enterobacter4 (1.4)5 (2.2)9 (1.7)0.74Enterobacter cloacae19 (6.5)*3 (1.3)22 (4.2)0.003Enterobacter aerogenes15 (5.2)8 (3.5)23 (4.4)0.29Staphylococcus saprophyticus19 (6.5)17 (7.4)36 (6.9)0.73Staphylococcus epidermidis27 (9.3)19 (8.3)46 (8.9)0.70Staphylococcus &,#1072 ureus9 (3.1)4 (1.7)13 (2.5)0.33Staphylococcus gallinarium1 (0.3)-1 (0.2)-Citrobacter freundii1 (0.3)-1 (0.2)-Klebsiella oxytosa5 (1.7)3 (1.3)8 (1.5)0.72Klebsiella pneumoniae-6 (2.6)6 (1.1)-Streptococcus viridans-2 (0.9)2 (0.4)-Pseudomonas aeruginosa1 (0.3)5 (2.2)*6 (1.1)0.03Hafnia alvei-3 (1.3)3 (0.6)-Proteus mirabilis2 (0.7)7 (3.0)*9 (1.7)0.05Candida albicans15 (5.2)16 (7.0)31 (5.9)0.38Candida glabrata16 (5.5)14 (6.1)30 (5.7)0.79Total290 (100)229 (100)519 (100) *Comparing uropatogens in group I and group II Chi square test was used to compare pathogen distributions between groups. |
| نویسندگان مقاله |
Shynar Yeleupayeva |
Department of General Biology and Genomics, L.N. Gumilyov Eurasian National University, Astana, Kazakhstan
Aigul Dinmukhamedova |
Department of General Biology and Genomics, L.N. Gumilyov Eurasian National University, Astana, Kazakhstan
Roman Aizman |
Department of Anatomy, Physiology and Life Safety, Novosibirsk State Pedagogical University, Novosibirsk, Russian
Zhanat Mukataeva |
Department of General Biology and Genomics, L.N. Gumilyov Eurasian National University, Astana, Kazakhstan
Bibenur Baidalinova |
Higher School of Natural Science, Pavlodar State Pedagogical University, Pavlodar, Kazakhstan
Saule Bazarbaeva |
Department of Biology, M. Kozybayev North-Kazakhstan State University, Petropavlovsk, Kazakhstan
Muhametkali Zhakupov |
Department of Internal Diseases, Astana Medical University, Astana, Kazakhstan
Zhanar Rakhimzhanova |
Department of Normal Physiology, Astana Medical University, Astana, Kazakhstan
Aisulu Kuzenbayeva |
Department of Medical Genetics and Molecular Biology, Astana Medical University, Astana, Kazakhstan
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