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. Keywords: children, complicated pneumonia, bacteriological diagnosis, antibiotic resistance.

У дітей раннього віку, хворих на позалікарняну пневмонію, серед ускладнень наростає частота токсичного синдрому в поєднанні з гнійним ендобронхітом паралельно зростанню ступеня тяжкості дефіциту заліза. Серед клініко-рентгенологічних форм переважає двобічна вогнищева пневмонія (84,2 %), рідко (9,7 %) спостерігається часткова та сегментарна (6,1 %). Гнійні форми ендобронхіту переважали в дітей першого року життя (81,2 %), на другому-третьому році життя вони спостерігались рідше (30,5 %). Із промивних вод бронхів найчастіше висівали Streptococcus pneumoniaе (49,2 %), Staphylococcus аureus, зокрема, у дітей першого року життя (20,3 %), рідше — Pseudomonas аeruginosae (13,5 %), що є чутливими до антибіотиків резерву та інгібітор-захищених пеніцилінів.

The theme is relevant due to the diagnostic difficulties, severe clinical course and prognosis of idiopathic pulmonary hemosiderosis and Goodpasture syndrome. Idiopathic pulmonary hemosiderosis and Goodpasture syndrome are severe, life-threatening immunopathologic diseases due to alveolar hemorrhage and a hundred percent mortality within a short period of time after the onset of clinical manifestations. Idiopathic pulmonary hemosiderosis generally occurs in children at the age of 3–8 years as a separate condition, or as a stage of Goodpasture syndrome. It manifests itself as shortness of breath, pneumonia, prune juice sputum, hemoptysis, hemorrhage. During exacerbation, the patients' condition is determined by the degree of pulmonary hemorrhage, pulmonary heart disease, acute posthemorrhagic anemia. The exacerbation lasts from a few hours to 1–2 weeks. The duration of each episode and remission varies among patients being unpredictable. Each new exacerbation is more severe. In Goodpasture syndrome, predominant pulmonary and renal vascular lesions of autoimmune nature are observed. It affects young males more frequently; is rare in children. Hemorrhagic alveolitis as a form of lung damage develops first; then, the kidneys are involved, and anemia occurs. Glomerulonephritis (GN) manifests itself as nephrotic syndrome with rapid progression of kidney failure. In case of the predominant pulmonary pathology, recurrent hemoptysis and pulmonary hemorrhage are observed; in end-stage disease with cardiopulmonary failure manifestations, rapidly progressive GN and kidney failure develop. The second variant of Goodpasture syndrome is characterized by relatively slow progression of pulmonary changes and renal lesions. Goodpasture syndrome is rarely accompanied by GN from the onset to the end of the disease and pulmonary pathology manifests itself at the terminal phase of the disease. The treatment of both diseases includes lifetime therapy with glucocorticoids, cytostatics. Pulse therapy using these preparations, discrete plasma exchange and intravenous immunoglobulin administration, syndromic treatment are carried out. No conflict of interest was declared by the authors. Keywords: children, idiopathic pulmonary hemosiderosis, Goodpasture syndrome, clinical course, therapy.

Gianotti-Crosti syndrome is a kind of infectious exanthem. That is characterized by the appearance of monomorphic papules, which colour may be from the skin colour to pink-red ones. The most typical location is on the face, buttocks and extensor surfaces of the limbs. Over time, the rash disappears spontaneously and the medical treatment becomes symptomatic. Currently, the pathophysiological changes are not still thoroughly studied. It is clear that the syndrome represents an immunological response to the previous viremia and bacteraemia; perhaps, it is the delayed-type hypersensitivity reaction. Purpose - to acquaint doctors with criteria of the papular acrodermatitis for a timely diagnostic and a correct treatment strategy. Clinical case. There was a described clinical case of Gianotti-Crosti syndrome in a child of 2. The parents had complained about rashes on the face, limbs, buttocks for 6 weeks. The severe restlessness and itching of the skin had been present. During the whole time, the child was examined by various specialists. Alternative diagnoses were: an atopic dermatitis, a food allergy, a worm infestation. The child was prescribed local zinc-containing agents, systemic and local glucocorticosteroids, antiviral drugs, antibacterial therapy, antihistamines, sorbents, probiotics and a three-time course of deworming in the process of the treatment. The treatment have not had a positive therapeutic effect. Conclusions. Gianotti-Crosti syndrome is most common in childhood. At present, we consider it a self-limited disease that does not require specific treatment. Recent studies proved that the syndrome is more commonly associated with a variety of viral and bacterial pathogens. However, insufficient knowledge of papular acrodermatitis may lead to groundless and continuous examinations and treatment of children. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

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