Volume 03 Issue 05-2023
67
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
05
P
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:
67-74
SJIF
I
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FACTOR
(2021:
5.
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)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The basis of this study was the results of treatment of 176 sick children with acute bacterial destructive pneumonia. In
the treatment of this pathology, a new approach to the treatment of inflammatory infiltrates of the lung was used,
based on the optimal choice of an antibiotic administered percutaneously-intrapulmonary to the lesion, which
prevented the transition of the disease to a purulent-destructive stage. And also tested a differentiated method of
drainage treatment of severe pleural complications of acute bacterial destructive pneumonia (ABDP) in children.
KEYWORDS
Acute bacterial destructive pneumonia, intrapulmonary administration of antibiotics, differentiated drainage
treatment, empirical therapy, thoracocentesis, microflora.
INTRODUCTION
Acute bacterial destructive pneumonia (ABDP) is one
of the most severe purulent-septic diseases of
childhood (1,3,14,17,25). The share of various forms of
destructive pneumonia accounts for 10% to 15% of the
total number of pneumonias in children (2,7,19). Many
scientific works have been devoted to the treatment of
acute bacterial lung destruction in children, and
scientists of different generations have formed the
basic principles for the diagnosis and treatment of this
pathology at the present stage (4,8,11,24).
All this largely determines the level of medical care for
patients with bacterial destruction of the lungs in
children. Despite the success achieved in the diagnosis
Research Article
TO THE TREATMENT OF ACUTE BACTERIAL DESTRUCTIVE PNEUMONIA
IN CHILDREN
Submission Date:
May 20, 2023,
Accepted Date:
May 25, 2023,
Published Date:
May 30, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue05-10
Mekhriddinov M.K.
Bukhara State Medical Institute Bukhara, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 05-2023
68
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
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P
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67-74
SJIF
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FACTOR
(2021:
5.
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(2022:
5.
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)
(2023:
6.
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)
OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
and treatment of acute bacterial destructive
pneumonia in children, it remains a formidable
pathology in children and is one of the main causes of
child mortality, which forces scientists to continue
studying the features of this pathology (13,18,21).
In the list of necessary complex therapy for acute
destructive pneumonia, a rather wide range of surgical
methods of treatment occupies a special place, in the
choice of which the form of acute destructive
pneumonia plays a leading role (5,10,12,16,23).
Despite significant advances in the diagnosis and
treatment of ABDP, it remains a formidable disease in
young children (2,6,7,22). Over the past decade, there
has been a gradual displacement of staphylococcus
from etiological agents due to a wide range of gram-
negative flora, as well as its association. (1,3,9,11,19).
Achievements in surgical and medical treatment of
ABDP have had some success, but they need to be
further improved. There is a need to develop and put
into practice more gentle and effective methods of
drainage treatment of ABDP in childhood (5,6,7,15,20).
Aim: surgical treatment are timely and adequate
sanitation of the pleural cavity and persistent re-
expansion of the lung.
MATERIAL AND METHODS
The present work is based on the data of examination
and treatment of 176 patients with ABDP. When
studying the clinical and radiological picture of the
disease, in each case we identified several clinical
groups. Most of the patients were children with
exudative pleurisy - 31.3% and pyopneumothorax -
31.8%. The frequency of pleural complications was
significantly higher in children under 3 years of age -
78.4%. The main contingent of patients were children
of the first three years of life, including: 30.7% - under
the age of one year, from one to three years old made
up the majority (47.7%) of the observed patients.
Among the examined patients, there were slightly
more boys (54.3%) than girls (45.7%). It should be noted
that in 83.7% of patients, acute bacterial destructive
pneumonia occurred against the background of
various concomitant diseases and complications,
which were predominantly observed in children of the
first three years of life. In infancy, frequent
concomitant diseases were anemia (90.3%), rickets
(47.3%), malnutrition (30.2%), exudative diathesis
(8.9%), etc. It is important to emphasize that 94% of
children history of acute viral infection and pneumonia.
To solve the tasks set by us, clinical, radiological and
laboratory research methods were applied.
RESULTS
When studying the etiological structure of ABDP
obtained during bacteriological examination, we used
two indicators: the frequency of detection of the
pathogen from among all examined and from among
the
positive
results
of
the
tank.
sowing.
Volume 03 Issue 05-2023
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Publisher:
Oscar Publishing Services
Servi
Staphylococcus aureus was sown most often - in 49
cases out of 152 studies, which amounted to 32.2%. This
figure rises to 62% of positive samples (79).
Pseudomonas aeruginosa is in second place - 9.8% and
18%, respectively. Associations of bacteria, more often
staphylococcus with Pseudomonas aeruginosa and
Escherichia coli, were noted.
Thus, the traditional methods of bacteriological study
of the focus of destruction, due to the low frequency
of registration of pathogens and the duration of the
study, do not allow the initiation of targeted, timely
antibiotic therapy. In addition, it is often impossible to
obtain material for a tank. sowing from the focus of the
pathological
process
(inflammatory
infiltrate,
pneumothorax, bullae, fibrinous pleurisy).Considering
that antibiotic therapy is urgent, it would be rational to
prescribe antibiotics targeted, taking into account the
pathogen and its sensitivity to antibiotics. However,
the fulfillment of this requirement at the initial stages
of the disease is not realistic, therefore, at the initial
stages,
we
prescribed
antibiotics
based
on
staphylococcal etiology, either gram-negative, less
often mixed. For treatment ABDP used antibiotics that
have an antistaphylococcal effect and broad-spectrum
antibiotics
-
3-4
generation
cephalosporins
(ceftriaxone, rocefin, cefepime, etc.), which clinically
gave a positive result from the first days of treatment.
As the results of bacteriological studies were obtained,
antibiotics were prescribed taking into account the
sensitivity of the isolated pathogens of the
pathological process. Decrease in intoxication,
normalization of temperature, appetite, decrease in
the amount of contents from the drainage tube and
during puncture, improvement in breathing, negative
results of bacteriological studies indicated the
beginning of remission. A quick identification of the
causative agent of the disease ABDP allows you to
choose an antibiotic that is sensitive to this type of
bacteria
and
immediately
begin
antibacterial
treatment of patients with ABDP.
The choice of antibiotics allows immediate initiation of
antibiotic therapy by injection into the lesion. We used
intrapulmonary administration of antibiotics in the
infiltrate zone in 31 children. We chose the antibiotic
after determining the causative agent of the disease
and carried out targeted antibiotic therapy. With lobar
infiltrate, the use of intrapulmonary antibiotics in the
complex of therapeutic measures made it possible to
achieve recovery in 93.5% of patients (29 patients). 2
patients (5%) had pneumothorax. Intrapulmonary
administration of antibiotics makes it possible to
create a high concentration of antibiotics in the area of
inflammation, prevent the development of severe
pleural complications, and in some cases contribute to
the abortive course of the pathological process. In
general, the method of intrapulmonary administration
of antibiotics, used according to indications,
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Publisher:
Oscar Publishing Services
Servi
In pulmonary-pleural forms of ABDP, the main goal of
drainage treatment is to remove air and fluid from the
pleural cavity and straighten the lung to prevent its re-
collapse. Thoracocentesis with drainage of the pleural
cavity was performed in 72 patients. In the present
study, according to the method of drainage treatment,
patients were divided into two groups in order to
determine the comparative effectiveness of the new
and traditional approaches to drainage treatment.
Traditional drainage, including trocar-drainage, is
usually introduced urgently, without taking into
account the localization of the lesion; as a rule, along
the VI-VII intercostal space, mid-axillary line, and the
differentiation approach involved the introduction of a
trocar-drainage at the level of the lesion, taking into
account its localization. Patients who underwent
thoracocentesis with drainage of the pleural cavity
using a trocar-drainage according to the traditional
method
comprised
group
I
(17
children).
Pyopneumothorax and pneumothorax were observed
in 15 patients (88%). Pyothorax in 2 patients (12%). When
treated with trocar drainage, the condition of patients
improved faster and the lung expanded, which was
observed in 6 patients (35%). However, in 9 children
(53%), a favorable clinical course was not accompanied
by lung expansion. They noted a gradual, slow
expansion of it. In 7 patients, the lung expanded
slowly, after 2-3 weeks. In general, the use of trocar
drainage made it possible to achieve recovery in 16
patients (94%). 1 patient (5%) from this group died. The
length of stay of patients in the hospital was 34.1±0.8
bed-days. The thoracocentesis opening on the chest
wall healed 27.2±1.1 days after removal of the drain.
Patients of group II - 55 children, we used the method
of differentiated drainage of the pleural cavity.
Pyopneumothorax was noted in 48 children (87%),
pyothorax in 7 children (13%). When treated in a
differentiated way, a rapid improvement in the
condition with the expansion of the lung in the first
hours and days was observed in 47 patients (87%), in 6
patients (11%) after a few days, only in 1 child (2%) the
lung expanded in the late stages of treatment. , after
the imposition of the second drainage 1-2 intercostal
space above the injection site in the first drainage. The
length of stay of patients in the hospital was 25.2±0.5
bed-days. The thoracocentesis wound on the chest
wall healed in 18.2±6 days. Died 2 children (3.6%) of 55
patients in this group. The cause of adverse events
here cannot be associated with the use of this method
(in all the deceased, the lung remained straightened
until the onset of death. In all cases there was a
progressive septicopyemia).
CONCLUSIONS
1. A new approach to the treatment of inflammatory
infiltrates of the lung was applied, based on the
optimal choice of an antibiotic administered
percutaneously-intrapulmonary to the lesion, which
Volume 03 Issue 05-2023
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International Journal of Medical Sciences And Clinical Research
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VOLUME
03
ISSUE
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FACTOR
(2021:
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)
(2023:
6.
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)
OCLC
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Publisher:
Oscar Publishing Services
Servi
prevented the transition of the disease to a purulent-
destructive stage in 93% of patients.
2. A new differentiated method of drainage treatment
of severe pleural complications of acute destructive
pneumonia in children has been tested and introduced
into clinical practice, which makes it possible to obtain
a more pronounced clinical effect compared to
traditional treatment.
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