Effect of microbial landscape on the character of antibacterial therapy in newborns with necrotizing enterocolitis

Abstract

Проведена клинико-микробиологическая оценка лечения 67 новорожденных, оперированных по поводу прогрессирующего некротизирующего энтероколита (НЭК). С учетом полученных результатов корригировалась стартовая антибактериальная терапия (АБТ), включающая меропенем и ванкомицин (70,7 %) -ванкомицин заменяли на линезолид, а меропенем -на цефтазидим/цефепим. При выявлении резистентной Грмикрофлоры использовали ципрофлоксацин (9,8 %). При высеве неферментирующего микроорганизма S. maltophilia назначали ко-тримоксазол (6,4 %), при обнаружении грибов Candida non-albicans -микафунгин или амфотерицин (8,0 %). Среднее количество схем АБТ у детей с 3-й стадией НЭК составило 3,35±0,31. Таким образом, использование дифференцированного подхода к терапии НЭК с учетом данных микробиологического исследования позволило снизить летальность пациентов до 39,3±6,57 %. Ключевые слова: новорожденные, некротизирующий энтероколит, микробиологическое исследование, антибактериальная терапияA clinical and microbiological assessment of the treatment of 67 newborns operated on for progressive necrotizing enterocolitis (NEC) was carried out. Taking into account the results obtained, initial antibiotic therapy (ABT) was corrected, including meropenem and vancomycin (70.7 %): vancomycin was replaced with linezolid, and meropenem -with ceftazidime/cefepime. Ciprofloxacin (9.8 %) was used to identify resistant Gr-microflora. When the non-fermenting microorganism S. maltophilia was inoculated, co-trimoxazole (6.4 %) was prescribed, if Candida non-albicans fungi were found, micafungin or amphotericin (8.0 %) was prescribed. The average number of ABT regimens in children with stage 3 NEC was 3.35±0.31. Thus, the use of a differentiated approach to NEC therapy, taking into account the data of a microbiological study, made it possible to reduce the mortality of patients to 39.3±6.57 %.

Evaluation of short-term outcomes in preterm infants with necrotizing enterocolitis

“…N ecrotizing enterocolitis (NEC) remains the most common cause of disability and death in children. To date, the incidence of NEC is about 6.3 % (2.5:1000) of newborns of the total number of children admitted to neonatal intensive care units (ICU) [1][2][3]. The principle of open resuscitation is to organize the child's stay with parents in the ICU and the professional activities of the department's staff, which provides for a family-oriented approach to the treatment and care of patients [3].…”

Biomarkers of necrotizing enterocolitis through the prism of etiopathogenesis

“…Markers for early and differential diagnosis describe the main etiopathogenetic mechanisms of disease development. Markers characterizing intestinal tissue damage, specific inflammatory markers [13][14][15] come to the fore.…”

“…An increase in L-lactate in the cord blood of premature newborns will indicate a pronounced hypoxic state, developed by perinatal hypoxia, predisposed to the development of NEC [31]. An increase in the level of lactate in the venous blood, if diagnosed with NECs, may develop predominantly in a severe general condition of the child and will not indicate a specific lesion of the intestine [13].…”