Peculiarities of intensive care at destructive pneumonias in children

Authors

  • Марина Александровна Макарова Zaporozhye State Medical University, str. Novgorodskaya, 28a, Zaporozhye, Ukraine, 69006, Ukraine

DOI:

https://doi.org/10.15587/2313-8416.2015.47391

Keywords:

child, bacterial pneumonia, intensive care, microorganism, pneumococcus, bronchoscopy, thoracoscopy.

Abstract

In spite of success in treatment and diagnostics attained last years the problem of an acute pneumonia remains actual, this fact is caused by the growing rate of prolonged clinical course and unfavorable clinical outcomes. The growth of antibiotic resistance of microflora is a substantial problem. In addition even the most vigorous modern antibacterial preparations are not effective without an adequate surgical sanitation of the nidus of infection.

The aim of the work is to improve the therapy of destructive pneumonia in children that need an intensive care.

Methods. 12 patients 9 month – 12 years old who underwent the treatment of heavy community-acquired pneumonia were under observation. There was carried out an X-ray examination at admission and in dynamics, microbiological examination of lavages from the respiratory tract, pleural exudate and blood, determination of laboratory indexes of intoxication (by Kalf-Kalif, Dashtayants, Lubimova) and the level of the middle molecules. The statistical analysis was done using the program package "Microsoft Excel" and "StatSoft 6".

Results. In the course of microbiological examination it was demonstrated the prevalence of gram-negative flora and its associations with gram-positive one, the purely gram-positive flora was detected only in 25 % of children. So there was proved an inefficiency of antibiotics that effect mainly on the gram-positive microorganisms. In addition the cephalosporins of the third generation were found insufficiently effective. Such preparations as carbapenems or protected penicillins were chosen in vitro and according to its clinical efficiency. Plasmapheresis and bronchoscopy are useful in the complex therapy. Thoracoscopy must be carried out if the conservative treatment is not effective

Conclusions. At present the gram-negative flora and its associations with gram-positive one prevails in etiological structure of the heavy community-acquired pneumonias that must be taken into account choosing the start preparations for empirical therapy. In the cases of insufficient efficiency of conservative therapy an active surgical tactics must be used. 

Author Biography

Марина Александровна Макарова, Zaporozhye State Medical University, str. Novgorodskaya, 28a, Zaporozhye, Ukraine, 69006

Chair of Pediatric Surgery and Anesthesiology

Candidate of Medical Sciences

References

Lassi, Z. S., Imdad, A., Bhutta, Z. A. (2015). Short-course versus long-course intravenous therapy with the same antibiotic for severe community-acquiredpneumonia in children aged two months to 59 months. Cochrane Database Syst Rev. – Available at: http://www.ncbi.nlm.nih.gov/pubmed/26077639 doi: 10.1002/14651858.CD008032.pub2

Nudga, A. N., Kovalyova, E. A., Galinskaya, V. A., Sidorenko, O. A., Ponomarenko, A. I. (2006). Hard Pneumonias with Fatal Outcome (Analysis, Course, Features). Meditsina Neotlozhnykh Sostoyanij, 5 (6). – Available at: http://www.mif-ua.com/archive/article_print/945

Mendes, R. E., Hollingsworth, R. C., Costello, A., Jones, R. N., Isturiz, R. E., Hewlett, D., Farrell, D. J. (2015). Non-invasive Streptococcus pneumoniae serotypes recovered from hospitalized adult patients in the United States (2009-2012). Antimicrobial Agents and Chemotherapy, AAC.00182–15. – Available at: http://www.ncbi.nlm.nih.gov/pubmed/26124173. doi: 10.1128/aac.00182-15

Marimón, J. M., Morales, M., Cilla, G., Vicente, D., Pérez-Trallero, E. (2015). Detection of bacteria and viruses in the pleural effusion of children and adults with community-acquired pneumonia. Future Microbiology, 10 (6), 909–915. doi: 10.2217/fmb.14.143

Jroundi, I., Mahraoui, C., Benmessaoud, R., Moraleda, C., Benjelloun, B., Bassat, Q. (2015). Knowledge gaps on paediatric respiratory infections in Morocco, Northern Africa. Archives of Public Health, 73 (1), 28. doi: 10.1186/s13690-015-0076-x

Shabalov, N. P. (2003). Pneumonias in Young Age Children. Lechaschij Vrach, 2. – Available at: http://www.lvrach.ru/2003/02/4530038

Kozlov, R. S., Stetsyuk, O. U., Andreeva, I. V. (2007). Contemporary Trends of Antibiotic Resistance of Nosocomial Infection Exciters in Russia ICU: What is waiting for Us Further? Intensivnaya terapiya, 4. – Available at: http://www.icj.ru/2007-04-01.html

Williams, D. J., Edwards, K. M., Self, W. H., Zhu, Y., Ampofo, K., Pavia, A. T., Grijalva, C. G. (2015). Antibiotic Choice for Children Hospitalized With Pneumonia and Adherence to National Guidelines. PEDIATRICS, 136 (1), 44–52. doi: 10.1542/peds.2014-3047

Zhang, Y., Chen, Y., Chen, Z., Zhou, Y., Sheng, Y., Xu, D., Wang, Y. (2014). Effects of Bronchoalveolar Lavage on Refractory Mycoplasma pneumoniae Pneumonia. Respiratory Care, 59 (9), 1433–1439. – Available at: http://www.ncbi.nlm.nih.gov/pubmed/24962224. doi: 10.4187/respcare.03032

Zuo Y., Yang Y., Hong J., Wu Z., Yu L., Tao J., Gong S. (2014). Analysis on diagnosis and treatment of 15 cases with severe influenza A. Zhonghua Er Ke Za Zhi, 52 (2), 142–145. – Available at: http://www.ncbi.nlm.nih.gov/pubmed/24739728

Published

2015-07-29

Issue

Section

Medical