Department of Pediatrics, Alexandria University, Faculty of Medicine, El-Shatby Hospital Alexandria, Egypt.
Department of Pediatrics, Alexandria University, Faculty of Medicine, El-Shatby Hospital Alexandria, Egypt.
J Glob Antimicrob Resist. 2019 Sep;18:88-94. doi: 10.1016/j.jgar.2019.01.028. Epub 2019 Jan 30.
Due to the current widespread bacterial resistance to many antibiotics - especially extended-spectrum β-lactams, carbapenems, and anti-pseudomonal drugs - therapy for severe pneumonia is very challenging. This study aimed to assess antimicrobial sensitivity patterns and optimisation of the antibiotic stewardship program applied at a university-affiliated paediatric intensive care unit (PICU).
This prospective cohort study included all patients aged 1 month to 12 years, admitted to the PICU with severe pneumonia episodes indicated for mechanical ventilation, and were followed up and investigated. Non-bronchoscopic bronchoalveolar lavage specimens were tested for positive microbiological yields and examined for their susceptibility pattern.
Of 85 patients with 96 episodes, 69 of them yielded positive growth: 43 were community-acquired pneumonia episodes, 62.79% of which were of unidentified cause. The isolated bacteria were predominantly due to Chlamydia pneumonia (18.6%) followed by Staphylococcus aureus and its resistant form (9.3%). Hospital and ventilator-associated pneumonia were mainly related to Gram-negative bacteria (91.67% and 87.8%, respectively), especially Klebsiella acinetobacter and Pseudomonas. There was a significant increase in multi-drug resistance among Gram-negative bacteria, which was considered an independent risk factor of mortality (P=0.003).
Severe community-acquired pneumonia was treated with macrolides in combination with vancomycin or linezolid if methicillin-resistant S. aureus was suspected. This was appropriate, in view of its causative agents and their susceptibility pattern. Hospital and ventilator-associated pneumonia caused by resistant Gram-negative organisms might have better outcomes by adding tigecycline or colistin in combination with fluoroquinolones. Owing to the widespread resistance of many Gram-negative bacteria, it is recommended that the antibiotic stewardship program be frequently updated.
由于目前许多抗生素（尤其是广谱β-内酰胺类、碳青霉烯类和抗假单胞菌类药物）的细菌耐药性广泛存在，严重肺炎的治疗极具挑战性。本研究旨在评估应用于大学附属儿科重症监护病房（PICU）的抗菌药物敏感性模式和抗生素管理计划的优化。
本前瞻性队列研究纳入所有 1 个月至 12 岁、因严重肺炎发作需要机械通气而入住 PICU 的患者，并进行随访和调查。对非支气管镜肺泡灌洗标本进行阳性微生物学产量检测，并检测其药敏模式。
在 85 例 96 例次的患者中，有 69 例次标本阳性：43 例为社区获得性肺炎，其中 62.79%病因不明。分离出的细菌主要为肺炎衣原体（18.6%），其次为金黄色葡萄球菌及其耐药形式（9.3%）。医院和呼吸机相关性肺炎主要与革兰氏阴性菌有关（分别为 91.67%和 87.8%），尤其是肺炎克雷伯菌和铜绿假单胞菌。革兰氏阴性菌的多药耐药性显著增加，被认为是死亡的独立危险因素（P=0.003）。
对于严重的社区获得性肺炎，如果怀疑有耐甲氧西林金黄色葡萄球菌，应使用大环内酯类药物联合万古霉素或利奈唑胺治疗。鉴于其病原体及其药敏模式，这是合适的。对于由耐药革兰氏阴性菌引起的医院和呼吸机相关性肺炎，联合使用替加环素或黏菌素联合氟喹诺酮类药物可能会有更好的疗效。由于许多革兰氏阴性菌广泛耐药，建议经常更新抗生素管理计划。
