Analysis of bacteriological diagnosis of complicated pneumonia in children and antibiotic resistance in isolated pathogens

Abstract

Purpose - to analyze the results of bacteriological diagnosis of complicated pneumonia in children and antibiotic resistance in isolated pathogens.

Materials and methods. There were analyzed inpatient medical records (form 003/o) of 1,175 patients with complicated pneumonia at the age from 2 months to 18 years treated at the Ivano-Frankivsk Regional Children’s Clinical Hospital of the Ivano-Frankivsk Regional Council during 2012-2020. Due to the severity of illness, 827 (70.4%) children were hospitalized to the anesthesiology department and intensive care unit. Among patients with community-acquired pneumonia, there were 248 (29.9%) one-year-old children. The rest of children (n=348 - 29.6%) were diagnosed with nosocomial pneumonia, including ventilator-associated pneumonia in 103 (29.6%) children.

In most cases (n=1,092 - 92.9%), complicated pneumonia developed secondary to purulent endobronchitis. Purulent pulmonary and pulmonary pleural pathological processes were less common (n=83 - 7.1%). A total of 3,196 bacteriological studies were carried out, including studies of bronchial aspirate (n=2,695 - 84.3%), pleural effusion (n=175 - 5.5%), and blood culture for sterility (n=326 - 10.2%).

Bacteriological studies were carried out in accordance with the Order of the Ministry of Health of Ukraine No. 167 on Approval of the Methodological Guidelines «Determination of the Sensitivity of Microorganisms to Antibacterial Drugs» dated April 05, 2007.

Results. During bacteriological investigation of bronchial tree aspirate, the positive results were obtained in 773 (28.7%) cases, there were isolated 956 pathogens, including 183 (23.7%) cases had a mixed infection. Gram-negative bacterial pathogens prevailed: Pseudomonas aeruginosaе (n=383 - 48.1%), Klebsiella рneumoniae (n=140 - 17.6%) and Acinetobacter baumannii (n=104 - 13.0%).

Gram-negative bacteria isolated from blood cultures were characterized by high resistance to the following reserve antimicrobials: carbapenems (68.4%-52.9%), fourth-generation cephalosporins (cefepime - 65.6%), third-generation cephalosporins (52.5%-31.6%) and to a lesser extent, to cephalosporins/beta-lactamase inhibitors. There was an upward trend in the resistance of isolated pathogens to fluoroquinolones, penicillin / beta lactamase inhibitors.

Gram-positive bacterial pathogens demonstrating high resistance to almost all antibiotic groups accounted for 16.6%, with Staphylocоccus aureus (76.1%) being the most predominant pathogen.

Conclusions. Over the past eight years, a high frequency of infecting by gram-negative microorganisms among patients with complicated pneumonia has been observed and high antibiotic resistance of isolated pathogens, especially to reserve antimicrobials, has been proven. Pseudomonas aeruginasaе, Klebsiella pneumoniaе, Acinetobacter baumannii are dominant among gram-negative pathogens causing complicated pneumonia.

Gram-positive bacterial pathogens of complicated pneumonia accounted for 16.6%, with Staphylocоccus aureus being the most predominant bacterium, and demonstrated a fairly high antibiotic resistance.

Both the compliance with the indications, dosage and treatment regimens and consideration of antibiotic sensitivity of pathogens in every medical institution are the most important prerequisites for reducing antibiotic resistance, as well as slowing down the spread of antifungal resistance and preventing generalized mycosis.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was adopted by the Local Ethics Committee of the institutions specified in the work. The informed consent of the parents or guardians of the children was obtained for the study.

No conflict of interests was declared by the authors.