Optimization of serious bacterial infections intensive therapy in children in Anesthesiology and Intensive Care Department

Abstract

Effective selection of antibiotics in children with severe bacterial infections is often difficult because of microflora resistance. Extracorporeal detoxication methods, particularly discrete plasmapheresis are usually used for septic shock and total organ failure prevention.

The aim of research. To conduct microbiological monitoring and to study a dynamics of medium molecular peptides in discrete plasmapheresis for intensive care optimization in children with severe bacterial infections in Anesthesiology and Intensive Care Department (AICU).

Materials and methods. We investigated respiratory tract microflora by bacteriological method in 120 newborns and 30 children from 1 month with severe bacterial infections at admission and during prolonged stay in AICU. Discrete plasmapheresis was held in four children. Dynamic of medium molecular peptides was studied at admission, before discrete plasmapheresis and after it. Statistical data processing was performed using the Microsoft Excel software package.

Results. It was found that in AICU in older children in admission grampositive and gramnegative flora was defined in equal quantity. The best sensitivity of the respiratory tract microflora was for the glycopeptides, oxazolidinones , II generation cephalosporins and macrolides, more than 60% - for aminoglycosides and lincosamides. However, when children spent more than 7-14 days in the department, nosocomial microflora was represented primarily by gram-negative organisms (80%), especially Pseudomonas aeruginosa. It was found to be inappropriate to use cephalosporins and macrolides in AICU for older children after their long stay there; the sensitivity to aminoglycosides was less than 60%, to anti-pseudomonal carbapenems not more than 30%.

In AICU of newborns grampositive flora was found in 95%, mostly Staphylococcus haemolyticus. It was entirely sensitive for glycopeptides, oxazolidinones, fluoroquinolones, carbapenems, and also for co-trimoxazole and for modern protected penicillin, such as piperacillin+tazobactam ticarcillin+clavulanic acid. In prolonged stay of newborns in AICU grampositive germs also occurred predominantly (65%), and according to their sensitivity glycopeptides, lincosamides and carbapenems should be used widely in this department, under vital indications oxazolidinones and fluoroquinolones may be prescribed.

We recommend discrete plasmapheresis conducting in hard bacterial toxemia cases if the level of fraction I medium molecular peptides is more than 0,5 and fraction II more than 0,3 absorbance units, or if their ratio coefficient is less than 1,5. Discrete plasmapheresis conducting leaded to the regression of level and normalization of relations between the middle molecules, indicating the devolution of intoxication syndrome.

         Conclusions. 1. Microbiological monitoring in Pediatric AICUs showed that in admission to AICU grampositive and gramnegative flora is defined in equal quantity; in AICU of newborns it was respectively 95% of gram-positive germs.2. Inadmission to AICU of older children good sensitivity to the most of modern antibacterial drugs was detected. At the same time it is inappropriate to use cephalosporins, macrolides, penicillins, including protected, and monobactams in AICU for older children after their long stay there. Most justified is aminoglycosides, carbapenems and kolomycin usage. 3. It was found that in AICU of newborns glycopeptides, III generation cephalosporins and carbapenems should be used widely, under vital indications oxazolidinones and fluoroquinolones may be prescribed. 4. Discrete plasmapheresis conducting leads to the regression of level and normalization of relations between the middle molecular peptides, indicating the devolution of intoxication syndrome.