Clinical and microbiological aspects of Enterococcus faecalis -associated urinary tract infection

Urinary tract infections (UTIs) pose a topical problem in current pediatrics, pediatric nephrology and urology. UTI-related clinical picture in childhood is polymorphic, sometimes being rather subtle and undergoing age-related alterations. Often, typical UTI symptoms in infants and early children occur subclinically. Microbe-related properties colonizing renal tissues dominate among multiple factors involved in developing UTI. In recent years, etiological importance of Enterococcus faecalis in development of such pathology has been increased. Our study was aimed to determine E. faecalis-associated UTI clinical signs in children and unveil their biological characteristics to assess related clinical significance.

Materials and methods. A nine-year pediatric UTI etiological pattern was analyzed at the multi-field pediatric clinical hospital. The data of clinical and laboratory examination of 181 UTI children aged 3 days — 17 years as well as microbiological study of 60 E. faecalis strains isolated from patient urine were obtained.

Results. Clinical and laboratory characteristics of E. faecalis-associated UTIs, age-related symptom variability were presented. Intoxication syndrome and fever dominated in the clinical picture. A key sign of UTIs was gastrointestinal dysfunction (in neonates and one-year old children) and pain in the lumbar region (in older children). The identified clinical symptoms may be associated with the upper urinary tract damage, concomitant diseases, and the pathogenic properties of E. faecalis. Other symptoms were less common, consistent with the age of the patients, although abdominalgia was equally common for children in all age groups. Data of laboratory examination also depended on patient age. It was noted that leukocytosis and thrombocytosis were more prominent in neonates, whereas leukocyturia and proteinuria — in children above one year of age, although clinical symptoms in this group were less overt. Specific features and clinical significance of E. faecalis-related biological properties, their heterogeneity related to patient age were noted. An inter-connected relationship between pathogenic properties and certain clinical symptoms was revealed.

Conclusion. The dominant clinical symptoms (intoxication, hyperthermia), indicative of damaged upper urinary system is related, among other things, to the set of E. faecalis biological properties exerting tissue-damaging and cytolytic effects.