Relationship between representation of various histocompatibility antigens and detection of pathogenic and saprophytic Staphylococcus strains as an etiological factor of secondary pyelonephritis in children with congenital obstructive uropathies

The study involved 73 patients aged 5-15 years of Russian origin upon hospital admission for surgical treatment of congenital obstructive uropathies (hydronephrosis, vesicoureteral reflux, megaureter). All patients underwent a full range of standard urological examinations, including urine cultures for microflora with an antibiotic resistance testing and microbial counts. Microbiological analysis of uropathogenic bacteria has revealed that Staphylococcus aureus (45.0%) and Staphylococcus epidermidis (22.5%) were most often cultured from the urine of patients. The children with secondary pyelonephritis underwent genotyping for the HLA-A and HLA-B loci. Statistical methods: canonical correspondence analysis, calculation of relative risk and odds ratio. The aim of our study was a search for relationships between the HLA Class 1 antigens of MHC complex (loci A and B of the HLA system), and positive findings of S. aureus and S. epidermidis in children with obstructive pyelonephritis. Results: We used the Past program (version 3.26, 2019) , with S. aureus and S. epidermidis taken as independent variables causing pyelonephritis in children, and histocompatibility antigens of loci A and B (dependent variables).  The combined relationships were revealed between HLA (A and B loci), being associated with detection of S. aureus and S. epidermidis in children with secondary pyelonephritis. The odd ratios for S. aureus were as follows: A28 (42.8), A27 (10.4), A11 (10.4), A26 (5.0), B28 (12.7), B15 (5.0), B1 (4.33). For S. epidermidis: A4 (6.7), A25 (4.9), B 41 (6.7), B16 (4.9). With, the highest significant relative risk for detecting S. aureus was revealed among pediatric patients with pyelonephritis who have HLA - A28 antigen, with relative risk of 24.5 (P=0.028), and odds ratio of 42.78 (P= 0.019). Conclusions: The obtained data may be used to predict the risk and clinical course of pyelonephritis, as well as to guide the strategy of etiotropic therapy of obstructive pyelonephritis in children.

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