Criteria for choosing antibiotic therapy for surgical sepsis in children

Abstract

BACKGROUND: Sepsis is one of the leading causes of hospital mortality in children. A decisive role in improving the results of treatment of this group of patients belongs to early diagnosis and pathogenetic therapy. AIM: This study optimizes the diagnosis and intensive care of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring. MATERIALS AND METHODS: The study period is 20182020. The study subjects were children (n = 73) with surgical pathology (diffuse purulent peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, injuries of the abdominal organs, and others). Clinical and laboratory parameters were analyzed, and microbiological monitoring was performed to determine antibiotic sensitivity. RESULTS: Patients who developed sepsis had a pronounced hypermetabolic syndrome, which was manifested by tachycardia and tachypnea, hyperthermia, low levels of albumin, and total protein in the blood. Protein catabolism in patients was accompanied by a decrease in globulins (IgG) synthesis and the development of a secondary immunodeficiency state. Both gram-positive and gram-negative microorganisms were involved in developing surgical sepsis in children, increasing the proportion of the latter. Given the high proportion of multi-resistant flora, empirical combined de-escalation antibiotic therapy (ABT) with broad-spectrum antibiotics was prescribed. This was followed by its revision based on microbiological monitoring and clinical and laboratory data of the patient with sepsis. Studies have shown the effectiveness of complex intensive care in 86.3% of cases. Mortality occurred in 13.7% of cases. Patients with severe surgical pathology died: fecal, generalized peritonitis, severe traumatic brain injury + coma with irreversible neurological disorders, and urosepsis against the background of chronic renal failure after repeated surgical interventions. CONCLUSIONS: Early diagnosis of sepsis, rational ABT under the control of microbiological monitoring, non-aggressive infusion therapy, and active sanitation of the surgical infection focus contributed to a decrease in mortality in this category of patients.