- Contemporary principles of diagnosis and treatment of pneumonia associated with medical care, hospital-acquired and ventilator-associated pneumonia in children: Review Up To Date 2017
Contemporary principles of diagnosis and treatment of pneumonia associated with medical care, hospital-acquired and ventilator-associated pneumonia in children: Review Up To Date 2017
SOVREMENNAYA PEDIATRIYA.2017.8(88):82-92; doi 10.15574/SP.2017.88.82
Gonchar' M. O., Logvinova O. L., Senatorova H. S., Muratov H. R.
Kharkiv National Medical University, Kharkiv, Ukraine
Communal Health Care Institution «Kharkiv Regional Children's Clinical Hospital», Kharkiv, Ukraine
Resume. Hospital-acquired and ventilator-associated pneumonia are common causes of morbidity and mortality in children of different age groups, despite improved modern respiratory care, a wide range of antibiotic therapy, and the possibility of disease prevention. Pneumonia associated with medical care has a course similar to the hospital-acquired pneumonia and includes the episode of pneumonia in patients who were hospitalized for >2 days during the last 90 days; or live in health care facilities and need permanent care; received intravenous and / or chemotherapy for the last 30 days; visited the hemodialysis department.
The purpose of this publication is to reduce the complications and mortality rate of children with pneumonia associated with medical care, hospital-acquired and ventilator-associated pneumonia by familiarizing pediatric pulmonologists, intensive care physicians, surgeons with current diagnostic and treatment recommendations. We have attempted to explore and analyze the data available from current sources on the principles of treatment for pneumonia associated with medical care, hospital-acquired and ventilator-associated pneumonia, and to synthesize current concepts for childhood patients. The article is based on the evidence base, strength and degree of evidence defined in each recommendation on patient management. Modern diagnostics of hospital-acquired pneumonia takes into account the timing of onset of the disease. In children with the late-onset of hospital-acquired pneumonia there is a high frequency of multidrug-resistant flora, therefore, more frequent combination therapy is chosen. Children with the early onset of hospital-acquired pneumonia are prescribed monotherapy of antibiotics. Most of the antibiotic therapy principles, which applied to the treatment of hospital-acquired pneumonia, can be also applied to the management of pneumonia associated with medical care. The etiology of ventilator-associated pneumonia is associated with aspiration of pathogens from the oropharynx and from the sites around the endotracheal cuff, determines the advantage of non-invasive ventilation techniques over mechanical ones. The review provides a detailed algorithm for the diagnosis of pneumonia associated with medical care, hospital-acquired and ventilator-associated pneumonia, as well as a differentiated approach to the antibiotic treatment of the patient.
Key words: children, hospital-acquired pneumonia, ventilator-associated pneumonia, pneumonia associated with medical care, diagnostics, treatment.
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