Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector93910.17816/psaic939Original Study ArticlesОригинальные исследованияResearch ArticleCriteria for choosing antibiotic therapy for surgical sepsis in childrenКритерии выбора антибиотикотерапии при хирургическом сепсисе у детейhttps://orcid.org/0000-0002-8448-26709896-8364SatvaldievaElmira A.СатвалдиеваЭльмира Абдусаматовна
Uzbekistan

Dr. Sci. (Med.), Professor, Head of the Department of Anesthesiology and Reanimatology, Pediatric Anesthesiology and Reanimatology

д-р мед. наук, профессор, заведующая кафедрой анестезиологии и реаниматологии, детской анестезиологии и реаниматологии

elsatanest@mail.ruhttps://orcid.org/0000-0003-0847-35851925-0828FayzievOtabek Ya.ФайзиевОтабек Якупджанович
Uzbekistan

Assistant of the Department of Anesthesiology and Reanimatology, Pediatric Anesthesiology and Reanimatology

ассистент кафедры анестезиологии и реаниматологии, детской анестезиологии и реаниматологии

fayziev.otabek@mail.ruhttps://orcid.org/0000-0001-6437-8967AshurovaGulchehra Z.АшуроваГулчехра Закиржановна
Uzbekistan

Assistant of the Department of Anesthesiology and Reanimatology, Pediatric Anesthesiology and Reanimatology

ассистент кафедры анестезиологии и реаниматологии, детской анестезиологии и реаниматологии

gulibaur@gmail.comhttps://orcid.org/0000-0003-0968-8780ShakarovaMehri U.ШакароваМехри Улашовна
Uzbekistan

Assistant of the Department of Anesthesiology and Reanimatology, Pediatric Anesthesiology and Reanimatology

ассистент кафедры анестезиологии и реаниматологии, детской анестезиологии и реаниматологии

tpmidar@mail.ruhttps://orcid.org/0000-0002-1710-1057IsmailovaMahfuza U.ИсмаиловаМахфуза Убайдуллаевна
Uzbekistan

Assistant of the Department of Anesthesiology and Reanimatology

ассистент кафедры анестезиологии и реаниматологии, детской анестезиологии и реаниматологии

maxfuza7319@gmail.comTashkent Pediatric Medical InstituteТашкентский педиатрический медицинский институтNational Сhildren Medical CenterНациональный детский медицинский центр16052022240720221221451561803202111052022Copyright ©; 2022, Satvaldieva E.A., Fayziev O.Y., Ashurova G.Z., Shakarova M.U., Ismailova M.U.Copyright ©; 2022, Сатвалдиева Э.А., Файзиев О.Я., Ашурова Г.З., Шакарова М.У., Исмаилова М.У.2022Satvaldieva E.A., Fayziev O.Y., Ashurova G.Z., Shakarova M.U., Ismailova M.U.Сатвалдиева Э.А., Файзиев О.Я., Ашурова Г.З., Шакарова М.У., Исмаилова М.У.https://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/939

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 2018–2020. 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.

Актуальность. Сепсис — одна из ведущих причин госпитальной летальности у детей. Решающая роль в улучшении результатов лечения этой группы больных принадлежит ранней диагностике и патогенетической терапии.

Цель исследования — оптимизация диагностики и интенсивной терапии хирургического сепсиса у детей на основе клинико-лабораторных критериев и бактериологического мониторинга.

Материалы и методы. Срок исследования — 2018–2020 гг. Объект исследования (n = 73) — дети с хирургической патологией (разлитой гнойный перитонит, бактериальная деструкция легких, посттравматические гематомы мозга, травмы органов брюшной полости и др.). Были проанализированы клинико-лабораторные показатели, проведен микробиологический мониторинг с определением чувствительности к антибиотикам.

Результаты. Пациенты, у которых развился сепсис, имели выраженный гиперметаболический синдром, который проявился тахикардией и тахипное, гипертермией, низкими уровнями альбумина и общего белка в крови. Белковый катаболизм у пациентов сопровождался снижением синтеза глобулинов (IgG) и развитием вторичного иммунодефицитного состояния. В развитии хирургического сепсиса у детей принимают участие как грампозитивные, так и грамнегативные микроорганизмы, с увеличением доли последних. Учитывая высокую долю мультирезистентной флоры, назначали эмпирическую комбинированную деэскалационную терапию антибиотиками широкого спектра действия с последующим ее пересмотром на основании микробиологического мониторинга и клинико-лабораторных данных септического больного. Исследования показали эффективность комплексной интенсивной терапии в 86,3 % случаях. В 13,7 % случаях констатирована летальность. Погибли пациенты с тяжелой хирургической патологией: каловым, распространенным перитонитом, тяжелой черепно-мозговой травмой + кома с необратимыми неврологическими расстройствами, уросепсисом на фоне хронической почечной недостаточности, после неоднократных хирургических вмешательств.

Заключение. Ранняя диагностика сепсиса, рациональная антибактериальная терапия под контролем микробиологического мониторинга, неагрессивная инфузионная терапия, активная санация хирургического очага инфекции способствуют снижению летальности в данной категории пациентов.

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