Микробный пейзаж и антимикробная терапия сепсиса/септического шока у детей и новорожденных
Аннотация
Цель. Представить обзор современных подходов к антимикробной терапии сепсиса и септиче- ского шока у детей и новорожденных с учётом рекомендаций международных гайдлайнов и микробиологической специфики детской популяции.
Материалы и методы. Проведён систематический анализ научной литературы за последние 10–15 лет, включая базы данных PubMed, eLibrary, Google Scholar и ScienceDirect, с фокусом на педиатрический сепсис, антибиотикотерапию и интенсивную терапию. Особое внимание уделено рекомендациям Surviving Sepsis Campaign (2020–2021) и результатам крупных много- центровых исследований.
Результаты. Этиологическая структура сепсиса у детей варьирует в зависимости от возраста и сопутствующих заболеваний. Основными возбудителями остаются грамотрицательные и грамположительные бактерии, с ростом доли резистентных штаммов. Отмечено, что ран- нее начало АБТ (в течение 1–3 часов) ассоциировано с улучшением клинических исходов. Эмпирическая терапия должна быть широкого спектра, но с последующей деэскалацией на основе микробиологических данных. Отдельное внимание уделяется индивидуализации доз и длительности лечения.
Заключение. Гемокультура остаётся основным методом диагностики септического процесса. При этом отсутствие бактериемии не исключает диагноза, если присутствуют клинико- лабораторные критерии сепсиса! Для бактериологического подтверждения сепсиса достаточно лишь одного позитивного результата при выделении таких патогенов, как St.aureus (MRSA), Str.pneumoniae, Klebsiella pneumoniae, Ps.aeruginosa, Acinetobacter baumannii и грибы. Своевре- менная АБТ (до 1 часа после установки диагноза) должна быть целью для детей с септическим шоком. Необходимо начинать АБТ как можно раньше после выявления сепсиса, оставляя при этом до 3 часов для диагностики у пациентов без клинических признаков шока. Решение о продолжении, сужении или прекращении АБТ часто должно приниматься на основе суждения клинициста и косвенной клинической информации с учетом клиники, локализации и типа инфекции, факторов риска и адекватности клинического улучшения.
Об авторах
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