Paediatric Department, MP Shah Hospital, Nairobi, Kenya.
Paediatric Department, University of Nairobi, Nairobi, Kenya.
Pan Afr Med J. 2019 Nov 7;34:133. doi: 10.11604/pamj.2019.34.133.15820. eCollection 2019.
Early empiric broad spectrum antibiotic administration in children with septic shock improves outcome. Knowledge on possible bacterial aetiology, drug resistance pattern and rational choice of antibiotics is crucial in management of septic shock.
This was an audit carried out among 50 (0- 5 years age) children admitted with septic shock at the Kenyatta National Hospital between October to December 2016. A standard questionnaire was used for data collection as per the Surviving Sepsis Guideline. Data were stored in Excel and analyzed in Strata 12.
Of the 50 admitted children with septic shock 86% were less than one-year age. Samples for blood cultures were removed from 12(24%) prior to administration of antibiotics. Blood culture bottles were unavailable in 80%. All children received antibiotics. Antibiotics were initiated in 44(88%) in the golden hour of diagnosis of septic shock. Monotherapy with cephalosporins 30 (60%) was the commonest choice of initial antibiotic. Antibiotics were changed in 7(22.6%) and 1(5.3%) at 24 and 48 hours respectively due to clinical deterioration. Over mortality at 72 hours was 35 (70%). All the 9 children initiated on meropenem monotherapy on admission died.
The majority of patients with septic shock were under one-year age. All patients were initiated on antibiotics. Blood cultures were done in a quarter of the patients. Monotherapy with cephalosporin was the commonest choice of antibiotic. De-escalation was not well accomplished due to microbiological culture limitation. There was no standard antibiotic choice hence antibiotic use in septic shock needs to be included in the paediatric local guidelines.
在患有感染性休克的儿童中早期经验性广谱抗生素治疗可改善预后。了解可能的细菌病因、耐药模式和抗生素的合理选择对感染性休克的治疗至关重要。
这是一项于 2016 年 10 月至 12 月在肯尼亚国家医院对 50 名（0-5 岁）患有感染性休克的儿童进行的审核。根据《存活败血症指南》，使用标准问卷进行数据收集。数据存储在 Excel 中，并在 Strata 12 中进行分析。
在 50 名患有感染性休克的住院儿童中，86%的年龄小于 1 岁。在给予抗生素之前，有 12 名（24%）儿童的血培养标本被取出。80%的儿童血培养瓶不可用。所有儿童均接受了抗生素治疗。在感染性休克的诊断黄金时间内，44 名（88%）儿童开始进行抗生素治疗。头孢菌素单药治疗（30%）是初始抗生素的最常见选择。由于临床恶化，分别有 7 名（22.6%）和 1 名（5.3%）儿童在 24 和 48 小时时更换抗生素。72 小时时的死亡率为 35（70%）。所有在入院时接受美罗培南单药治疗的 9 名儿童均死亡。
大多数感染性休克患者年龄在 1 岁以下。所有患者均开始接受抗生素治疗。四分之一的患者进行了血培养。头孢菌素单药治疗是最常见的抗生素选择。由于微生物培养受限，降阶梯治疗未得到很好的实施。没有标准的抗生素选择，因此感染性休克中的抗生素使用需要纳入儿科当地指南。
