The widespread of acute pneumonia is a major threat to children. Knowledge on the local epidemiology and antibiotic resistance pattern is a platform in improving the empiric antibiotic therapy. The aim of the work – to increase the effectiveness of intensive care (IC) in children aged 1-7 years old with complicated community-acquired pneumonia (CAP) by substantiating empiric antibiotic therapy; to evaluate the microbiological peculiarities of the pathogens’ distribution at the local level and assessing its antibiotic sensitivity in conjunction with clinical characteristics. Object and methods. It is a retrospective analysis, cohort study, one-centred research. From 2002 through 2018, we enrolled children aged 1-7 years old with complicated community-acquired pneumonia (CAP) (4-th and 5-th degree of severity), hospitalized at pediatric intensive care unit (PICU) in the Municipal Children’s Hospital (MCH) №5, Zaporizhzhia, Ukraine. Group I included children with discrete plasmapheresis usage in complex IC, group II – children who received baseline therapy (BT). Each of the groups were divided into subgroups: A – children aged 1-3 years old, B – children aged 3-7 years old. The studies were carried out in the bacteriological laboratory of MCH № 5, using the standard disco-diffusion method for determining the sensitivity of microorganisms to antibiotics with the evaluation of the results by EUCAST 2016 criteria. MRSA was determined in the test with oxacillin or cefoxitin. Samples from the upper respiratory tract (pharynx, nose), lower respiratory tract (tracheo-bronchial swabs), pleural punctate were studied. 398 samples were analyzed. Results and discussion. Positive microbiological results at the admission of children to PICU were detected in 61 cases (70,11%) – 174 strains of bacteria, 31 strains of fungi, atypical pathogens were not detected, in one case was detected RNA of influenza A virus, in another – posthumously cytologically and morphologically parainfluenza virus. In the majority, pathogen associations were encountered: monocultures were obtained in 25.42%, microbial associations – in 74.58% of cases. The most widespread etiologic bacteria of complicated CAP in children aged 1-7 years old is Streptococcus (Str.pneumoniae is dominated), Haemofilus, Moraxella catarrhalis and S.aureus. Local resistance pattern of the most common etiological pathogens of complicated CAP in children aged 1-7 years in Zaporizhzhia has been revealed. With prolonged stay of children in PICU, the proportion of detection of Pseudomonas and Acinetobacter in-hospital strains among Gram-negative microorganisms increases. Conclusions 1. Enterobacteriaceae family are more common in children aged 1-3 years old than in preschool children. 2. Local drug resistance to the most unprotected penicillins, macrolides, cephalosporins of the 1st generation, lincosamides is shown. The risk factor for multidrug-resistant (MDR) infection at admission in children aged 1-7 years old with complicated CAP is the presence of acute infectious diseases at the previous 3 month. 3. In Zaporizhzhia for severe complicated CAP in children aged 1-7 years old it is rational to prescribe empirical antibiotics therapy in PICU of β-lactams without antipseudomonas activity (cephalosporins of 2-3 generations, amoxiclav) in combination with glycopeptide or glycopeptide with aminoglycoside in the case of β-lactams allergy; in the presence of risk factors for MDR-infection – carbapenem with glycopeptide; in the presence of risk factors for pseudomonas-infection – β-lactams with antipseudomonas activity and glycopeptide.
pneumonia, child, plasmapheresis, anti-bacterial agents, antibacterial drug resistance
«Bulletin of problems biology and medicine» Issue 3 (152), 2019 year, 88-93 pages, index UDK 616.24-002-06-053.2/.4-085.33.015.8-093
