Инфекция мочевых путей у детей. Роль первичного звена здравоохранения в диагностике и лечении инфекции мочевых путей у детей

Захарова И.Н., Османов И.М., Горяйнова А.Н., Тамбиева Е.В., Шестериков Н.В. Инфекция мочевых путей у детей. Роль первичного звена здравоохранения в диагностике и лечении инфекции мочевых путей у детей. Педиатрия. Consilium Medicum. 2025;1:23–31. DOI: 10.26442/26586630.2025.1.203219

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Zakharova IN, Osmanov IM, Goryainova AN, Tambieva EV, Shesterikov NV. Urinary tract infection in children. The role of primary health care in the diagnosis and management of urinary tract infection in children: A review. Pediatrics. Consilium Medicum. 2025;1:23–31. DOI: 10.26442/26586630.2025.1.203219

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Аннотация

Своевременная диагностика инфекции мочевых путей (ИМП) необходима для назначения адекватной антибактериальной терапии, препятствующей развитию нефросклероза, ренальной гипертензии, хронической почечной недостаточности. Известно, что уже первый эпизод ИМП, протекающий с лихорадкой, может вызвать изменения структуры почки у 50–85% детей при позднем назначении антибиотиков независимо от того, есть аномалии развития мочевых путей или нет. С этих позиций роль первичного звена здравоохранения, участкового врача-педиатра имеет первостепенное значение. Знание факторов риска развития ИМП, клинических признаков болезни у детей разных возрастных групп, методов обследования является условием эффективной антибактериальной терапии, профилактики рецидивов ИМП и диспансерного наблюдения.

Ключевые слова: дети, инфекция мочевых путей, пиелонефрит, цистит, асимптоматическая бактериурия, антибактериальная терапия, профилактика рецидивов, фитотерапия

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Timely diagnosis of urinary tract infection (UTI) is crucial for adequate antibacterial therapy that prevents nephrosclerosis, renal hypertension, and chronic renal failure. Even the first episode of UTI with fever can cause changes in the kidney's structure in 50-85% of children with delayed antibiotic administration, regardless of the presence of urinary tract congenital abnormalities. Therefore, the role of the primary health care provider, the local pediatrician, is of paramount importance. Awareness of risk factors for UTI development, clinical signs of the disease in children of different age groups, and examination methods is a prerequisite for effective antibacterial therapy, prevention of UTI relapse, and follow-up.

Keywords: children, urinary tract infection, pyelonephritis, cystitis, asymptomatic bacteriuria, antibacterial therapy, relapse prevention, phytotherapy

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Список литературы

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1. Hellström A, Hanson E, Hansson S, et al. Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child. 1991;66:232-4.
2. Hay AD, Costelloe C. Antibiotics for childhood urinary tract infection: can we be smarter? Br J Gen Pract. 2013;63(609):175-6. DOI:10.3399/bjgp13X665099
3. Schmiemann G, Kniehl E, Gebhardt K, et al. The Diagnosis of Urinary Tract Infection. Dtsch Arztebl Int. 2010;107(21):361-7.
4. Søraas A, Sundsfjord A, Sandven I, et al. Risk Factors for Community-Acquired Urinary Tract Infections Caused by ESBL-Producing Enterobacteriaceae – A Case-Control Study in a Low Prevalence Country. PLoS One. 2013;8(7):e69581. DOI:10.1371/journal.pone.0069581
5. Hay AD, Sterne JAC, Hood K, et al. Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study. Ann Fam Med. 2016;14:325-36. DOI:10.1370/afm.1954
6. Hay AD, Birnie K, Busby J, et al. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness. Health Technol Assess. 2016;20(51).
7. Coulthard MG, Lambert HJ, Vernon SJ, et al. Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits. Arch Dis Child. 2014;99(4):342-7. DOI:10.1136/archdischild-2013-304428
8. Coulthard MG, Lambert HJ, Vernon SJ, et al. Guidelines to identify abnormalities after childhood urinary tract infections: a prospective audit. Arch Dis Child. 2014;99(5):448-51. DOI:10.1136/archdischild-2013-304429
9. Coulthard MG, Verber I, Jani JC, et al. Can prompt treatment of childhood UTI prevent kidney scarring? Pediatr Nephrol. 2009;24(10):2059-63. DOI:10.1007/s00467-009-1233-7
10. Walawender L, Hains DS, Schwaderer AL. Diagnosis and imaging of neonatal UTIs. Pediatr Neonatol. 2020;61(2):195-200. DOI:10.1016/j.pedneo.2019.10.003
11. Lavelle JM, Blackstone MM, Funari MK, et al. Two-Step Process for ED UTI Screening in Febrile Young Children: Reducing Catheterization Rates. Pediatrics. 2016;138(1):e20153023.
12. Zorc JJ, Darcie A, Kiddoo DA, Shaw KN. Diagnosis and Management of Pediatric Urinary Tract Infections. Clin Microbiol Rev. 2005;18(2):417-22.
13. Downing H, Thomas-Jones E, Gal M, et al. The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness. BMC Infect Dis. 2012;12:158. DOI:10.1186/1471-2334-12-158
14. Coulthard MG, Kalra M, Lambert HJ, et al. Redefining urinary tract infections by bacterial colony counts. Pediatrics. 2010;125(2):335-41. DOI:10.1542/peds.2008-1455
15. Coulthard MG, Nelson A, Smith T, Perry JD. Point-of-care diagnostic tests for childhood urinary-tract infection: phase-contrast microscopy for bacteria, stick testing, and counting white blood cells. J Clin Pathol. 2010;63(9):823-9. DOI:10.1136/jcp.2010.077990
16. Copp HL, Schmidt B. Work up of Pediatric Urinary Tract Infection. Urol Clin North Am. 2015;42(4):519-26. DOI:10.1016/j.ucl.2015.05.011
17. Morfn-Otero R, Noriega ER, Dowzicky MJ. Antimicrobial susceptibility trends among gram-positive and -negative clinical isolates collected between 2005 and 2012 in Mexico: results from the Tigecycline Evaluation and Surveillance Trial. Ann Clin Microbiol Antimicrob. 2015;14:53. DOI:10.1186/s12941-015-0116-y
18. Paschke AA, Zaoutis T, Conway PH, et al. Previous antimicrobial exposure is associated with drug-resistant urinary tract infections in children. Pediatrics. 2010;125:664-72.
19. Rodriguez-Bano J, Alcala JC, Cisneros JM, et al. Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Arch Intern Med. 2008;168:1897-902.
20. Infektsiia mochevykh putei. 2024. Klinicheskie rekomendatsii. Available at: https://cr.minzdrav.gov.ru/preview-cr/281_3. Accessed: 14.01.2025 (in Russian).
21. Kantutis SS, Sadomskaya NA, Anikeeva NA, et al. Some aspects of antibiotic resistance of pathogens isolated from urine in children with urinary tract infections. Clincal Microbiology and Antimicrobial Chemotherapy. 2019;21(S1):32-3 (in Russian).
22. Han SB, Lee SC, Lee SY, et al. Aminoglycoside therapy for childhood urinary tract infection due to extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae. BMC Infect Dis. 2015;15:414.
23. Mori R, Lakhanpaul M, Verrier-Jones K. Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ. 2007;335:395-7.
24. Allen UD, MacDonald N, Fuite L, et al. Risk factors for resistance to “first-line” antimicrobials among urinary tract isolates of Escherichia coli in children. CMAJ. 1999;160:1436-40.
25. Edlin RS, Shapiro DJ, Hersh AL, et al. Antibiotic resistance patterns of outpatient pediatric urinary tract infections. J Urol. 2013;190:222-7.
26. Pilmis B, Delory T, Groh M, et al. Extended-spectrum beta-lactamaseproducing Enterobacteriaceae (ESBL-PE) infections: are carbapenem alternatives achievable in daily practice? Int Infect Dis. 2015;39:62-7.
27. Madhi F, Jung C, Timsit S, et al. Febrile urinary-tract infection due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in children: A French prospective multicenter study. PloS One. 2018;13(1):e0190910. DOI:10.1371/journal.pone.0190910
28. Armand-Lefèvre L, Angebault C, Barbier F, et al. Emergence of imipenem-resistant gram-negative bacilli in intestinal flora of intensive care patients. Antimicrob Agents Chemother. 2013;57:1488-95.
29. Roberts KB. The Diagnosis of UTI: Concentrating on Pyuria. Pediatrics. 2016;138(5):e20162877.
30. Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009;361:1748-59.
31. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) 2010 to 2014. Report 2015. November 2015, London, 130 p.
32. Apisarnthanarak A, Kirastisin P, Mundy LM. Predictors of mortality from community-onset bloodstream infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Infect Control Hosp Epidemiol. 2008;29:671-4.
33. Hanna-Wakim RH, Ghanem ST, El Helou MW, et al. Epidemiology and characteristics of urinary tract infections in children and adolescents. Front Cell Infect Microbiol. 2015;5:45.
34. Heras IP, Sanchez-Gomez JC, Beneyto-Martin P, et al. Community-onset extended-spectrum b-lactamase producing Escherichia coli in urinary tract infections in children from 2015 to 2016 Prevalence, risk factors, and resistances. Medicine (Baltimore). 2017;96(50):e8571. DOI:10.1097/MD.0000000000008571
35. 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. DOI:10.1097/INF.0b013e31815e4122
36. Thaden JT, Fowler Jr VG, Sexton DJ, Anderson DJ. Increasing Incidence of Extended-Spectrum β-Lactamase Producing Escherichia coli in Community Hospitals throughout the Southeastern United States. Infect Control Hosp Epidemiol. 2016;37(1):49-54. DOI:10.1017/ice.2015.239
37. Kunin CM. A ten-year study of bacteriuria in schoolgirls: final report of bacteriologic, urologic, and epidemiologic findings. J Infect Dis. 1970;122(5):382-93.
38. Newman TB. The New American Academy of Pediatrics Urinary Tract Infection Guideline. Pediatrics. 2011;128:572-75.
39. Urinary tract infection in children diagnosis, treatment and long-term management. Clinical Guideline August 2007. London.
40. Baranov AA, Kozlov RS, Namazova-Baranova LS, et al. Infektsiia mochevyvodiashchikh putei u detei: klinicheskie rekomendatsii. Moscow. 2021. Available at: https://cr.minzdrav.gov.ru/schema/281_2. Accessed: 14.01.2025 (in Russian).
41. Bryce А, Hay AD, Lane IF, et al. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ. 2016;352:i939. DOI:10.1136/bmj.i939
42. Wettergren B, Jodal U, Jonasson G. Epidemiology of bacteriuria during the first year of life. Acta Paediatr Scand. 1985;74:925-33.
43. Hansson S, Martinell J, Stokland E, Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am. 1997;11:499-512.
44. Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2011;(3):CD001534. DOI:10.1002/14651858.CD001534.pub3
45. Lindberg U, Claesson I, Hanson LA, Jodal U. Asymptomatic bacteriuria in schoolgirls. VIII. Clinical course during a 3-year follow-up. J Pediatr. 1978;92:194-9.
46. Hoberman A, Chesney RW; RIVUR Trial Investigators. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014;371:1072-3.
47. Toubiana J, Timsit S, Ferroni A, et al. Community-Onset Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France. Medicine (Baltimore). 2016;95(12):e3163. DOI:10.1097/MD.0000000000003163
48. Mattoo TK. Evidence for and against urinary prophylaxis in vesicoureteral reflux. Pediatr Nephrol. 2010;25(12):2379-82. DOI:10.1007/s00467-010-1632-9
49. Conway PH, Cnaan A, Zaoutis T, et al. Recurrent Urinary Tract Infections in Children. Risk Factors and Association With Prophylactic Antimicrobials. JAMA. 2007;298(2):179-86.
50. The RIVUR Trial Investigators. Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux. N Engl J Med. 2014;370(25):2367-76. DOI:10.1056/NEJMoa1401811
51. Sihra N, Goodman A, Zakri R, et al. Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol. 2018;15(12):750-76.
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Авторы

И.Н. Захарова¹, И.М. Османов^2,3, А.Н. Горяйнова*¹, Е.В. Тамбиева³, Н.В. Шестериков³

¹ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
²ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России (Пироговский Университет), Москва, Россия;
³ГБУЗ «Детская городская клиническая больница им. З.А. Башляевой» Департамента здравоохранения г. Москвы, Москва, Россия
*alex.goriaynowa@yandex.ru

________________________________________________

Irina N. Zakharova¹, Ismail M. Osmanov^2,3, Aleksandra N. Goryainova*¹, Ekaterina V. Tambieva³, Nikolai V. Shesterikov³

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
²Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia;
³Bashlyaeva Children’s City Clinical Hospital, Moscow, Russia
*alex.goriaynowa@yandex.ru

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