11.06.2019

New possibilities in the improvementof antibacterial therapy of hard abdominal infections in children

Кurochkin M.Yu., Davydova A.H., Кapustа V.M., Каpustin S.А., Horodkova Yu.V.

Key words: Purulent inflammatory diseases of the abdominal cavity, children, antibacterial therapy

INTRODUCTION. One of the directions of the antibacterial therapy of severe abdominal infections optimization is the use of new drugs that have a wide spectrum of antimicrobial activity.

PURPOSE OF THE WORK. To investigate the opportunities for antibacterial therapy improving in severe purulent inflammatory diseases of the abdominal cavity in children.

MATERIALS AND METHODS. The study involved 23 children aged 3-17 years who were in the intensive care unit for severe abdominal infections. The first group (n = 12) included children who received standard antibacterial therapy in the postoperative period - ceftriaxone, amikacin and metronidazole. The second group (n = 11) consisted of children who received monotherapy with piperacillin / tazobactam.

RESULTS AND DISCUSSION. When conducting a microbiological study, the gram-negative flora was 75%. The most common were Pseudomonas aeruginosa (33%); Klebsiella (17%), ß-hemolytic Streptococci (17%), E. coli, Cytrobacter, Proteus and Enterococcus (8% each). Most microorganisms were sensitive to carbapenems (80%) and to amikacin (80%). The sensitivity to cephalosporins was from 40 to 57%. Sensitivity to protected penicillins was low, except for piperacillin / tazobactam, which was found to be active against 85% of microorganisms.

In children of the first group, the average stay in OAIT and CD was 4.3 ± 0.65 days, in the second group - 3.45 ± 0.69 days (p <0.05). Among the patients of the second group, who received piperacillin / tazobactam as a starting antibacterial therapy, there was no need to perform extracorporeal methods of detoxification, whereas in the control group, two patients underwent discrete plasmapheresis. The change of antibiotic on the third day of treatment was carried out in 4 patients of the first group and in one patient of the 2nd group.

CONCLUSIONS

  1. The use of piperacillin / tazobactam (Tazpen) as a starting antibacterial therapy for severe purulent-inflammatory diseases of the abdominal cavity in childhood is theoretically and microbiologically justified.
  2. Monotherapy Piperacillin / tazobactam (Tazpen) in severe abdominal infections in children allows to achieve better treatment results by decreasing the manifestations of intoxication syndrome and reducing the length of the child's stay in the intensive care department.

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