Лечение инфекции мочевых путей у детей: что мы имеем на сегодняшний день? Обзор мировых и российских рекомендаций

Захарова И.Н., Османов И.М., Касьянова А.Н. Лечение инфекции мочевых путей у детей: что мы имеем на сегодняшний день? Обзор мировых и российских рекомендаций. Педиатрия. Consilium Medicum. 2019; 2: 20–25.
DOI: 10.26442/26586630.2019.2.190502

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Zakharova I.N., Osmanov I.M., Kasjanova A.N. Treatment of urinary tract infections in children: current perspectives and situation. Overview of global and Russian recommendations. Pediatrics. Consilium Medicum. 2019; 2: 20–25.
DOI: 10.26442/26586630.2019.2.190502

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Аннотация

Инфекция мочевых путей (ИМП) является одной из наиболее распространенных среди бактериальных инфекций у детей. Клиницисты в различных странах, занимающиеся проблемой ИМП, активным образом обсуждают подходы к ее диагностике и лечению. Результатом таких обсуждений становится разработка клинических рекомендаций, основанных на мнениях разных специалистов, занимающихся проблемой ИМП, включая педиатров, нефрологов, урологов, а также микробиологов. Мировые клинические рекомендации регулярно дополняются новыми сведениями, особенно это касается антибактериальной терапии ИМП ввиду быстро возрастающей антибиотикорезистентности уропатогенных микроорганизмов. В статье представлены современные данные о структуре ИМП у детей в Российской Федерации. Рассмотрены основные подходы к лечению ИМП, отраженные в рекомендациях мировых и отечественных медицинских сообществ. Представлены наиболее актуальные данные о резистентности уропатогенов к большому спектру антибактериальных препаратов. Подчеркивается необходимость проведения постоянного мониторинга чувствительности выделенной флоры мочи к антибиотикам в каждом регионе и разработки современных клинических рекомендаций по диагностике и лечению ИМП у детей, которые будут основываться на рациональном подходе с учетом меняющейся чувствительности уропатогенов к антибактериальным препаратам.
Ключевые слова: инфекция мочевых путей, дети, терапия, антибиотикорезистентность.

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Urinary tract infection (UTI) is one of the most common infections among bacterial infections in children. Clinicians in various countries dealing with UTI are actively discussing approaches to its diagnosis and treatment. The result of such discussions is the development of clinical recommendations based on the opinions of various specialists involved in the problem of UTI, including pediatricians, nephrologists, urologists, and microbiologists. World clinical recommendations are regularly supplemented with new information, especially with regard to antibiotic therapy for UTI due to the rapidly increasing antibiotic resistance of uropathogenic microorganisms. The article presents modern data on the structure of UTI in children in the Russian Federation. The main approaches to the treatment of UTI are reflected in the recommendations of world and domestic medical communities. The most relevant data on the resistance of uropathogens to a wide range of antibacterial drugs are presented. The need for constant monitoring of the sensitivity of the excreted urine flora to antibiotics in each region and the development of modern clinical recommendations for the diagnosis and treatment of UTI in children, which will be based on a rational approach, taking into account the changing sensitivity of uropathogens to antibacterial drugs, are emphasized.
Key words: urinary tract infection, children, therapy, antibiotic resistance.

Список литературы

1. Kocak M, Buyukkaragoz B, Celebi Tayfur A et al. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection. Pediatr Int 2016; 58: 467–71.
2. Quigley R. Diagnosis of urinary tract infections in children. Curr Opin Pediatrics 2009; 21: 194–8.
3. Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health 2017; 37 (4): 273–9.
4. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008; 27 (4): 302–8.
5. Spencer JD, Schwaderer A, McHugh K et al. Pediatric urinary tract infections: an analysis of hospitalizations, charges, and costs in the USA. Pediatrics Nephrol 2010; 25 (12): 2469–75.
6. Чугунова О.Л., Шумихина М.В. Инфекция мочевой системы у детей: актуальные вопросы. Эффективная фармакотерапия. 2015; 22: 10–21.
[Chugunova O.L., Shumikhina M.V. Infektsiia mochevoi sistemy u detei: aktual'nye voprosy. Effektivnaia farmakoterapiia. 2015; 22: 10–21 (in Russian).]
7. Zorc JJ, Levine DA, Platt SL et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics 2005; 116 (3): 644–8.
8. Stein R, Dogan HS, Hoebeke P et al. European Association of Urology; European Society for Pediatric Urology. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2015; 67 (3): 546–58.
9. Федеральные клинические рекомендации по оказанию медицинской помощи детям с инфекцией мочевыводящих путей. М.: Союз педиатров России, 2017.
[Federal clinical guidelines for providing medical care for children with urinary tract infection. Moscow: Soiuz pediatrov Rossii, 2017 (in Russian).]
10. Kanellopoulos TA, Salakos C, Spiliopoulou I et al. First urinary tract infection in neonates, infants and young children: a comparative study. Pediatr Nephrol 2006; 21: 1131–7.
11. Захарова И.Н., Османов И.М., Мумладзе Э.Б. и др. Инфекция мочевых путей у детей: что нужно знать педиатру и нефрологу. Мед. совет. 2015; 14: 114–8.
[Zakharova I.N., Osmanov I.M., Mumladze E.B. et al. Infektsiia mochevykh putei u detei: chto nuzhno znat' pediatru i nefrologu. Med. sovet. 2015; 14: 114–8 (in Russian).]
12. Захарова И.Н., Османов И.М., Мачнева Е.Б. и др. Лечение и профилактика инфекций мочевых путей у детей: обзор ведущих рекомендаций европейских экспертов. Педиатрия (Прил. к журн. Consilium Medicum). 2017; 1: 10–6.
[Zakharova I.N., Osmanov I.M., Machneva E.B. et al. Treatment and prevention of urinary tract infections in children: an overview of the leading recommendations of European experts. Pediatrics (Suppl. Consilium Medicum). 2017; 1: 10–6 (in Russian).]
13. Захарова И.Н., Мачнева Е.Б., Мумладзе Э.Б., Ивахненко Ю.И. Диагностика и лечение инфекций мочевых путей у детей: что нового? Мед. совет. 2017; 1: 180–5.
[Zakharova I.N., Machneva E.B., Mumladze E.B., Ivakhnenko Iu.I. Diagnostika i lechenie infektsii mochevykh putei u detei: chto novogo? Med. sovet. 2017; 1: 180–5 (in Russian).]
14. Kemper K, Avner E. The case against screening urinalyses for asymptomatic bacteriuria in children. Am J Dis Child 1992; 146 (3): 343–6.
15. Clinical practice guideline from American Academy of pediatrics. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics 2011; 128 (3): 593–610.
16. Палагин И.С., Сухорукова М.В., Дехнич А.В. и др. Современное состояние антибиотикорезистентности возбудителей внебольничных инфекций мочевых путей в России: результаты исследования «ДАРМИС» (2010–2011). Клин. микробиология и антимикробная химиотерапия. 2012; 14 (4): 280–302.
[Palagin I.S., Sukhorukova M.V., Dekhnich A.V. et al. Sovremennoe sostoianie antibiotikorezistentnosti vozbuditelei vnebol'nichnykh infektsii mochevykh putei v Rossii: rezul'taty issledovaniia "DARMIS" (2010–2011). Klin. mikrobiologiia i antimikrobnaia khimioterapiia. 2012; 14 (4): 280–302 (in Russian).]
17. Кузьменков А.Ю., Трушин И.В., Авраменко А.А. и др. AMRmap: интернет-платформа мониторинга антибиотикорезистентности. Клин. микробиология и антимикробная химиотерапия. 2017; 19 (2): 84–90. http://map.antibiotic.ru/
[Kuz'menkov A.Iu., Trushin I.V., Avramenko A.A. et al. AMRmap: internet-platforma monitoringa antibiotikorezistentnosti. Klin. mikrobiologiia i antimikrobnaia khimioterapiia. 2017; 19 (2): 84–90. http://map.antibiotic.ru/ (in Russian).]
18. Warren JW, Abrutyn E, Hebel JR et al. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 1999; 29 (4): 745–58.
19. Brandstrom P, Hansson S. Long-term, low-dose prophylaxis against urinary tract infections in young children. Pediatr Nephrol 2015; 30: 425–32.
20. Shaikh N, Hoberman A. Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis. In: Post TW, ed. UpToDate. Waltham, MA. (Accessed on August 10, 2018).
21. Kutasy B, Coyle D, Fossum M. Urinary Tract Infection in Children: Management in the Era of Antibiotic Resistance-A PediatricUrologist's View. Eur Urol Focus 2017; 3 (2–3): 207–11. doi: 10.1016/j.euf.2017.09.013
22. Allocati N, Masulli M, Alexeyev MF et al. Escherichia coli in Europe: anoverview. Int J Environ Res Public Health 2013; 10 (12): 6235–54.
23. Konca C, Tekin M, Uckardes F et al. Antibacterial resistance patterns of pediatric community-acquired urinary infection: overview. Pediatr Int 2017; 59: 309–15.
24. Lutter SA, Currie ML, Mitz LB, Greenbaum LA. Antibiotic resistance patterns in children hospitalized for urinary tract infections. Arch Pediatr Adolesc Med 2005; 159: 924–8.
25. Parajuli NP, Maharjan P, Parajuli H et al. High rates of multidrug resistance among uropathogenic Escherichia coli in children and analyses of ESBL producers from Nepal. Antimicrob Resist Infect Control 2017; 6: 9.
26. Mishra MP, Sarangi R, Padhy RN. Prevalence of multidrug resistant uropathogenic bacteria in pediatric patients of a tertiary carehospital in eastern India. J Infect Public Health 2016; 9: 308–14.
27. Catal F, Bavbek N, Bayrak O et al. Antimicrobial resistance patterns of urinary tract pathogens and rationale for empirical therapy in Turkish children for the years 2000–2006. Int Urol Nephrol 2009; 41: 953–7.
28. Oteo J, Orden B, Bautista V et al. CTX-M-15-producing urinary Escherichia coli O25b-ST131 phylogroup B2 has acquired resistance to fosfomycin. J Antimicrob Chemother 2009; 64 (4): 712–7.

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1. Kocak M, Buyukkaragoz B, Celebi Tayfur A et al. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection. Pediatr Int 2016; 58: 467–71.
2. Quigley R. Diagnosis of urinary tract infections in children. Curr Opin Pediatrics 2009; 21: 194–8.
3. Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health 2017; 37 (4): 273–9.
4. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008; 27 (4): 302–8.
5. Spencer JD, Schwaderer A, McHugh K et al. Pediatric urinary tract infections: an analysis of hospitalizations, charges, and costs in the USA. Pediatrics Nephrol 2010; 25 (12): 2469–75.
6. Chugunova O.L., Shumikhina M.V. Infektsiia mochevoi sistemy u detei: aktual'nye voprosy. Effektivnaia farmakoterapiia. 2015; 22: 10–21 (in Russian).
7. Zorc JJ, Levine DA, Platt SL et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics 2005; 116 (3): 644–8.
8. Stein R, Dogan HS, Hoebeke P et al. European Association of Urology; European Society for Pediatric Urology. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2015; 67 (3): 546–58.
9. Federal clinical guidelines for providing medical care for children with urinary tract infection. Moscow: Soiuz pediatrov Rossii, 2017 (in Russian).
10. Kanellopoulos TA, Salakos C, Spiliopoulou I et al. First urinary tract infection in neonates, infants and young children: a comparative study. Pediatr Nephrol 2006; 21: 1131–7.
11. Zakharova I.N., Osmanov I.M., Mumladze E.B. et al. Infektsiia mochevykh putei u detei: chto nuzhno znat' pediatru i nefrologu. Med. sovet. 2015; 14: 114–8 (in Russian).
12. Zakharova I.N., Osmanov I.M., Machneva E.B. et al. Treatment and prevention of urinary tract infections in children: an overview of the leading recommendations of European experts. Pediatrics (Suppl. Consilium Medicum). 2017; 1: 10–6 (in Russian).
13. Zakharova I.N., Machneva E.B., Mumladze E.B., Ivakhnenko Iu.I. Diagnostika i lechenie infektsii mochevykh putei u detei: chto novogo? Med. sovet. 2017; 1: 180–5 (in Russian).
14. Kemper K, Avner E. The case against screening urinalyses for asymptomatic bacteriuria in children. Am J Dis Child 1992; 146 (3): 343–6.
15. Clinical practice guideline from American Academy of pediatrics. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics 2011; 128 (3): 593–610.
16. Palagin I.S., Sukhorukova M.V., Dekhnich A.V. et al. Sovremennoe sostoianie antibiotikorezistentnosti vozbuditelei vnebol'nichnykh infektsii mochevykh putei v Rossii: rezul'taty issledovaniia "DARMIS" (2010–2011). Klin. mikrobiologiia i antimikrobnaia khimioterapiia. 2012; 14 (4): 280–302 (in Russian).
17.Kuz'menkov A.Iu., Trushin I.V., Avramenko A.A. et al. AMRmap: internet-platforma monitoringa antibiotikorezistentnosti. Klin. mikrobiologiia i antimikrobnaia khimioterapiia. 2017; 19 (2): 84–90. http://map.antibiotic.ru/ (in Russian).
18. Warren JW, Abrutyn E, Hebel JR et al. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 1999; 29 (4): 745–58.
19. Brandstrom P, Hansson S. Long-term, low-dose prophylaxis against urinary tract infections in young children. Pediatr Nephrol 2015; 30: 425–32.
20. Shaikh N, Hoberman A. Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis. In: Post TW, ed. UpToDate. Waltham, MA. (Accessed on August 10, 2018).
21. Kutasy B, Coyle D, Fossum M. Urinary Tract Infection in Children: Management in the Era of Antibiotic Resistance-A PediatricUrologist's View. Eur Urol Focus 2017; 3 (2–3): 207–11. doi: 10.1016/j.euf.2017.09.013
22. Allocati N, Masulli M, Alexeyev MF et al. Escherichia coli in Europe: anoverview. Int J Environ Res Public Health 2013; 10 (12): 6235–54.
23. Konca C, Tekin M, Uckardes F et al. Antibacterial resistance patterns of pediatric community-acquired urinary infection: overview. Pediatr Int 2017; 59: 309–15.
24. Lutter SA, Currie ML, Mitz LB, Greenbaum LA. Antibiotic resistance patterns in children hospitalized for urinary tract infections. Arch Pediatr Adolesc Med 2005; 159: 924–8.
25. Parajuli NP, Maharjan P, Parajuli H et al. High rates of multidrug resistance among uropathogenic Escherichia coli in children and analyses of ESBL producers from Nepal. Antimicrob Resist Infect Control 2017; 6: 9.
26. Mishra MP, Sarangi R, Padhy RN. Prevalence of multidrug resistant uropathogenic bacteria in pediatric patients of a tertiary carehospital in eastern India. J Infect Public Health 2016; 9: 308–14.
27. Catal F, Bavbek N, Bayrak O et al. Antimicrobial resistance patterns of urinary tract pathogens and rationale for empirical therapy in Turkish children for the years 2000–2006. Int Urol Nephrol 2009; 41: 953–7.
28. Oteo J, Orden B, Bautista V et al. CTX-M-15-producing urinary Escherichia coli O25b-ST131 phylogroup B2 has acquired resistance to fosfomycin. J Antimicrob Chemother 2009; 64 (4): 712–7.

Авторы

И.Н. Захарова*1, И.М. Османов2, А.Н. Касьянова1

1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования»
Минздрава России, Москва, Россия;
2 ГБУЗ «Детская городская клиническая больница им. З.А. Башляевой» Департамента здравоохранения г. Москвы
*zakharova-rmapo@yandex.ru

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Irina N. Zakharova*1, Ismail M. Osmanov2, Anna N. Kasjanova1

1 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
2 Bashlyaeva Children City Clinical Hospital, Moscow, Russia
*zakharova-rmapo@yandex.ru

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