Influence of immune mechanisms on pathogenesis and treatment of complicated urinary tract infections

Abstract

Introduction. Urinary tract infections (UTIs) include a number of pathological conditions characterized by microbial colonization of urine and microbial invasion with the development of an infectious process in any part of the genitourinary tract from the outer opening of the urethra to the renal cortex. UTIs lead to suppression of immunity, both cellular and humoral, as well as factors of nonspecific protection. Reduction of anti-infective factors, changes in the reactivity of the body during UTIs leads to prolonged persistence of the infectious agent, chronicity and recurrence of inflammatory processes.
The purpose of the study is optimization of complicated urinary tract infections treatment.
Material and methods. A comparative analysis of the treatment results of 120 patients with complicated urinary tract infections (patients with surgeries on the urinary tract organs in medical records and patients who subsequently planned surgical treatment to rehabilitate the organs of the urinary tract). These patients were divided into 2 groups: group 1 (n = 60) had a short course of antibiotic therapy, group 2 (n = 60) patients were prescribed a prolonged course of antibiotic therapy. In turn, each group was divided into subgroup A, where patients received targeted monotherapy, and subgroup B, where patients were prescribed immunocorrector and probiotic in addition to antibiotic therapy. We studied in details the antibiotic therapy results of all 120 patients, considering the results of bacteriological examination of urine to determine complicated forms of urinary tract infections (reinfection, superinjection and recurrence).
Results. At the beginning of treatment, patients had lymphopenia, initially low levels of absolute T-lymphocytes (38.2 ± 1.5% and 42.4 ± 1.4%, respectively, in groups 1B and 2B, p <0.01) and a significant increase in T -suppressors (36.7 ± 1.6% and 35.4 ± 1.1%, respectively, by groups, p <0.01) with a significant reduction in the number of T-helpers (24.5 ± 1.6% and 25.8 ± 1.6%, respectively, by groups, p <0.01). We also determined a significant increase in the concentration of IgG (by 1.59 times, p <0.01, respectively, in both groups), unreliable IgM (1.51 and 1.54 times, p = 0.02, respectively, by groups), and a significant decrease in IgA levels (by 59.6%, p <0.03 and 61.9%, p <0.01, respectively, in the groups) before treatment compared with the control group. The overall clinical cure in patients of the prolonged antibiotic therapy group in combination with probiotics and immunocorrector reached 93.3% of patients, which was significant (p <0.05) compared with other groups. The level of IgA increased by 33.3%, the level of IgG decreased by 55.8%, IgM decreased by 37.4%, which almost reached the values obtained in almost healthy people.
Conclusion. Using recombinant human interferon alfa-2b (1-2 million IU once a day) and a probiotic, the active substance of which is the spores of the multidrug-resistant strain Bacillus clausii (1 vial 5 ml twice a day), in the complex treatment of patients with CUTIs throughout the antibacterial cycle led to normalization of the level of immunocompetent cells and immunoglobulins, increased the functional (phagocytic) activity of segmental neutrophils, and improved cellular and humoral immunity. But the obtained values were significantly close to control values only for the duration of treatment up to 15 days.