Advertisement

World Journal of Pediatrics

, Volume 12, Issue 4, pp 425–429 | Cite as

Probiotics prophylaxis in pyelonephritis infants with normal urinary tracts

  • Seung Joo Lee
  • Jihae Cha
  • Jung Won LeeEmail author
Original article

Abstract

Background

Pyelonephritis in infants is considered as a major factor for the formation of renal scar. To prevent recurrent pyelonephritis and renal damage, prophylaxis is extremely important. The aim of this study was to compare the effectiveness of probiotic and antibiotic prophylaxis or no-prophylaxis in infants with pyelonephritis and normal urinary tract.

Methods

Altogether 191 infants, who were diagnosed with acute pyelonephritis, proven to have normal urinary tracts and followed up for 6 months on prophylaxis, were retrospectively evaluated. According to the types of prophylaxis, the infants were divided into three groups [probiotics (Lactobacillus species), antibiotics (trimethoprim/sulfamethoxazole, TMP/SMX), and noprophylaxis]. The incidence of recurrent urinary tract infection (UTI) during 6 months after the development of pyelonephritis, main causative uropathogens, and its antimicrobial sensitivities were compared.

Results

The incidence of recurrent UTI in the probiotic group was 8.2%, which was significantly lower than 20.6% in the no-prophylaxis group (P=0.035) and was not significantly different from 10.0% of the antibiotic group (P=0.532). The significant difference between the probiotic and no-prophylaxis groups was seen only in male infants (P=0.032). The main causative organism of recurrent UTI was Escherichia coli (E.coli), which was not different among the three groups (P=0.305). The resistance rate of E. coli to TMP/SMX was 100% in the antibiotic group, which was significantly higher than 25.0% in the probiotic group and 41.7% in the no-prophylaxis group (P=0.008).

Conclusion

Probiotic prophylaxis was more effective in infants with pyelonephritis and normal urinary tract than in those with no-prophylaxis. It could be used as a natural alternative to antibiotic prophylaxis.

Keywords

antibiotic prophylaxis antibiotic resistance probiotic prophylaxis pyelonephritis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Nuutinen M, Uhari M. Recurrence and follow-up after urinary tract infection under the age of 1 year. Pediatr Nephrol 2001;16:69–72.CrossRefPubMedGoogle Scholar
  2. 2.
    Benador D, Benador N, Slosman D, Mermillod B, Girardin EE. Are younger children at highest risk of renal sequelae after pyelonephritis? Lancet 1997;349:17–19.Google Scholar
  3. 3.
    Faust WC, Diaz M, Pohl HG. Incidence of post-pyelonephritic renal scarring: a meta-analysis of the dimercapto-succinic acid literature. J Urol 2009;181:290–297.CrossRefPubMedGoogle Scholar
  4. 4.
    Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 2010;126:1084–1091.CrossRefPubMedGoogle Scholar
  5. 5.
    Elder JS, Peters CA, Arant BS Jr, Ewalt DH, Hawtrey CE, Hurwitz RS, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol 1997;157:1846–1851.CrossRefPubMedGoogle Scholar
  6. 6.
    Elder JS. vesicoureteral reflux. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF. Nelson textbook of pediatrics, 20th edition. Philadelphia, PA: Elsevier Saunders, 2015: 2562–2567.Google Scholar
  7. 7.
    Taskinen S, Rönnholm K. Post-pyelonephritic renal scars are not associated with vesicoureteral reflux in children. J Urol 2005;173:1345–1348.CrossRefPubMedGoogle Scholar
  8. 8.
    Jakobsson B, Berg U, Svensson L. Renal scarring after acute pyelonephritis. Arch Dis Child 1994;70:111–115.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, McTaggart SJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009;361:1748–1759.CrossRefPubMedGoogle Scholar
  10. 10.
    Beetz R. May we go on with antibacterial prophylaxis for urinary tract infections? Pediatr Nephrol 2006;21:5–13.CrossRefPubMedGoogle Scholar
  11. 11.
    Nagler EV, Williams G, Hodson EM, Craig JC. Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev 2011;15:CD001532.Google Scholar
  12. 12.
    Williams GJ, Craig JC, Carapetis JR. Preventing urinary tract infections in early childhood. Adv Exp Med Biol 2013;764:211–218.CrossRefPubMedGoogle Scholar
  13. 13.
    RIVUR Trial Investigators, Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 2014;370:2367–2376.CrossRefGoogle Scholar
  14. 14.
    Manges AR, Johnson JR, Foxman B, O’Bryan TT, Fullerton KE, Riley LW. Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. N Engl J Med 2001;345:1007–1013.CrossRefPubMedGoogle Scholar
  15. 15.
    Fuller R. Probiotics in man and animals. J Appl Bacteriol 1989;66:365–378.CrossRefPubMedGoogle Scholar
  16. 16.
    Drisko JA, Giles CK, Bischoff BJ. Probiotics in health maintenance and disease prevention. Altern Med Rev 2003;8:143–155.PubMedGoogle Scholar
  17. 17.
    Abad CL, Safdar N. The role of lactobacillus probiotics in the treatment or prevention of urogenital infections—a systematic review. J Chemother 2009;21:243–252.CrossRefPubMedGoogle Scholar
  18. 18.
    Uehara S, Monden K, Nomoto K, Seno Y, Kariyama R, Kumon H. A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories inpatients with recurrent urinary tract infection. Int J Antimicrob Agents 2006;28 Suppl 1:S30–S34.CrossRefPubMedGoogle Scholar
  19. 19.
    Cadieux P, Burton J, Gardiner G, Braunstein I, Bruce AW, Kang CY, et al. Lactobacillus strains and vaginal ecology. JAMA 2002;287:1940–1941.CrossRefPubMedGoogle Scholar
  20. 20.
    Grin PM, Kowalewska PM, Alhazzan W, Fox-Robichaud AE. Lactobacillus for preventing recurrent urinary tract infections in women: meta-analysis. Can J Urol 2013;20:6607–6614.PubMedGoogle Scholar
  21. 21.
    Amdekar S, Singh V, Singh DD. Probiotic therapy: immunomodulating approach toward urinary tract infection. Curr Microbiol 2011;63:484–490.CrossRefPubMedGoogle Scholar
  22. 22.
    Beerepoot MA, Geerlings SE, van Haarst EP, van Charante NM, ter Riet G. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol 2013;190:1981–1989.CrossRefPubMedGoogle Scholar
  23. 23.
    Dani C, Biadaioli R, Bertini G, Martelli E, Rubaltelli FF. Probiotics feeding in prevention of urinary tract infection, bacterial sepsis and necrotizing enterocolitis in preterm infants. A prospective double-blind study. Biol Neonate 2002;82:103–108.PubMedGoogle Scholar
  24. 24.
    Gerasimov SV. Probiotic prophylaxis in pediatric recurrent urinary tract infections. Clin Pediatr (Phila) 2004;43:95–98.CrossRefGoogle Scholar
  25. 25.
    Lee SJ, Shim YH, Cho SJ, Lee JW. Probiotics prophylaxis in children with persistent primary vesicoureteral reflux. Pediatr Nephrol 2007;22:1315–1320.CrossRefPubMedGoogle Scholar
  26. 26.
    Lohr JA, Nunley DH, Howards SS, Ford RF. Prevention of recurrent urinary tract infections in girls. Pediatrics 1977;59:562–565.PubMedGoogle Scholar
  27. 27.
    Smellie JM, Katz G, Grüneberg RN. Controlled trial of prophylactic treatment in childhood urinary-tract infection. Lancet 1978;2:175–178.CrossRefPubMedGoogle Scholar
  28. 28.
    Bruce AW, Chadwick P, Hassan A, Van Cott GF. Recurrent urethritis in women. Can Med Assoc J 1973;108:973–976.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Gupta K, Stapleton AE, Hooton TM, Roberts PL, Fennell CL, Stamm WE. Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infections. J Infect Dis 1998;178:446–450.CrossRefPubMedGoogle Scholar
  30. 30.
    Lee JW, Shim YH, Lee SJ. Lactobacillus colonization status in infants with urinary tract infection. Pediatr Nephrol 2009;24:135–139.CrossRefPubMedGoogle Scholar
  31. 31.
    Reid G, Cook RL, Bruce AW. Examination of strains of lactobacilli for properties that may influence bacterial interference in the urinary tract. J Urol 1987;138:330–335.PubMedGoogle Scholar
  32. 32.
    Reid G, Bruce AW. Selection of lactobacillus strains for urogenital probiotic applications. J Infect Dis 2001;183 Suppl 1:S77–S80.CrossRefGoogle Scholar
  33. 33.
    Velraeds MM, van der Mei HC, Reid G, Busscher HJ. Inhibition of initial adhesion of uropathogenic Enterococcus faecalis by biosurfactants fromLactobacillus isolates. Appl Environ Microbiol 1996;62;1958–1963.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Rodríguez JM, Martínez MI, Horn N, Dodd HM. Heterologous production of bacteriocins by lactic acid bacteria. Int J Food Microbiol 2003;80:101–116.CrossRefPubMedGoogle Scholar
  35. 35.
    Matsuzaki T, Chin J. Modulating immune responses with probiotic bacteria. Immunol Cell Biol 2000;78:67–73.CrossRefPubMedGoogle Scholar
  36. 36.
    Asahara T, Nomoto K, Watanuki M, Yokokura T. Antimicrobial activity of intraurethrally administered probiotic Lactobacillus casei in a murine model of Escherichia coli urinary tract infection. Antimicrob Agents Chemother 2001;45:1751–1760.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Lee JW, Lee JH, Sung SH, Lee SJ. Preventive effects of Lactobacillus mixture on experimental E. coli urinary tract infection in infant rats. Yonsei Med J 2013;54:489–493.PubMedGoogle Scholar
  38. 38.
    Beerepoot MA, ter Riet G, Nys S, van der Wal WM, de Borgie CA, de Reijke TM, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med 2012;172:704–712.CrossRefPubMedGoogle Scholar
  39. 39.
    Caicedo RA, Schanler RJ, Li N, Neu J. The developing intestinal ecosystem: implications for the neonate. Pediatr Res 2005;58:625–628.CrossRefPubMedGoogle Scholar
  40. 40.
    Martín R, Langa S, Reviriego C, Jimínez E, Marín ML, Xaus J, et al. Human milk is a source of lactic acid bacteria for the infant gut. J Pediatr 2003;143:754–758.CrossRefPubMedGoogle Scholar
  41. 41.
    Lara-Villoslada F, Olivares M, Sierra S, Rodríguez JM, Boza J, Xaus J. Beneficial effects of probiotic bacteria isolated from breast milk. Br J Nutr 2007;98 Suppl 1:S96–S100.CrossRefPubMedGoogle Scholar
  42. 42.
    Mårild S, Hansson S, Jodal U, Odén A, Svedberg K. Protective effect of breastfeeding against urinary tract infection. Acta Paediatr 2004;93:164–168.CrossRefPubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of PediatricsEwha Women’s University School of MedicineSeoulKorea
  2. 2.Kangnam Sacred Heart HospitalHallym University School of MedicineSeoulKorea

Personalised recommendations