Prospective Study in Children with Complicated Urinary Tract Infection Treated with Autologous Bacterial Lysates

Abstract

Antimicrobial bacteria resistance is an important problem in children with recurrent urinary tract infections (rUTI), thus it is crucial to search for alternative therapies. Autologous bacterial lysates (ABL) may be a potential treatment for rUTI. Twenty-seven children with rUTI were evaluated for one year, urine and stool cultures were performed, 10 colonies of each culture were selected and those identified as Escherichia coli were characterized by serology. For patients who presented ≥105 UFC/mL, an ABL was manufactured and administered orally (1 mL/day) for a month. Twelve children were monitored for ≥1-year, 218 urine and 11 stool samples were analyzed. E. coli (80.5%) was the main bacteria isolated from urine and feces (72%). E. coli of classical urinary serotypes (UPEC), O25:H4, O75:HNM, and O9:HNM were identified in patients with persistent urinary infection (pUTI). In 54% of patients treated with ABL, the absence of bacteria was observed in urine samples after 3 months of treatment, 42% of these remained without UTI between 10–12 months. It was observed that the use of ABL controlled the infection for almost 1 year in more than 60% of the children. We consider it necessary to develop a polyvalent immunogen for the treatment and control of rUTI.

Polyvalent Bacterial Lysate with Potential Use to Treatment and Control of Recurrent Urinary Tract Infections

“…The UNAM-HIMFG polyvalent lysate was elaborated with 10 strains of E. coli , 7 of classical serogroups (O25, O75, O6, O8, O1, O16, and O7), and 3 considered as endemic (O9, O17, and O20), and with strains of Klebsiella pneumoniae , Klebsiella aerogenes , Citrobacter freundii , Proteus mirabilis , Staphylococcus haemolyticus , and Enterococcus faecalis , all bacteria isolated most frequently among patients of two previous studies [ 18 , 19 ]. The antimicrobial susceptibility profile assay of these strains reported multidrug-resistant patterns in all the microorganisms ( Tables S3 and S4 ).…”

“…Alrmroth E. Wright (1930) developed the first autovaccine when he considered that dead microorganisms, besides helping to prevent infections, could also contribute to their treatment [ 26 ]. In two previous studies, the effect of monovalent lysates was evaluated (autovaccines) in the treatment and control of recurrent urinary tract infections [ 18 , 19 ]. In the previously mentioned studies, E. coli of different serogroups was observed to be the most frequently isolated pathogen.…”

“…The composition ( Figure 1 ) includes a great diversity of components of different molecular weights that are recognized by antibodies from patients with persistent UTIs treated with a monovalent lysate prepared with a UPEC strain of serogroup O25:H4. In this assay ( Figure 2 ), LPS recognition was observed and found to have high specificity towards the homologous LPS (O25), but only in patients previously treated with the monovalent lysate [ 18 , 19 ], since serum from untreated patients did not induce a response.…”

“…In this situation, it is necessary to implement effective alternative therapies to reduce the use of antimicrobials. During two prospective studies of children and adults with chronic urinary tract infection (UTI), lysates of bacteria isolated from the same patient (autovaccines) were used as an alternative treatment; these were inactivated by heat treatment and sterilized by filtration [ 18 , 19 ]. Both groups of patients were followed for seven months to a year, with urine samples collected every month.…”

“…The use of complete microorganisms related to the etiopathogenesis of a condition such as UTI has the advantage of providing diverse immunogenic compounds that can induce an effective polyvalent response [ 20 ]. The purpose of the present study was to evaluate the immunostimulatory activity and safety of a polyvalent lysate prepared with previously isolated bacteria [ 18 , 19 ], to have a product with different antigenic components that allows the treatment and control of recurrent urinary tract infections, that is reliable and accessible to the population that requires it and can be used as an alternative to reduce the use of antimicrobials in cases of UTI.…”