The clinical and microbiological efficacy of vancomycin in the combination treatment of newborns with ventilator-associated pneumonia caused by gram-positive cocci
Abstract
The paper deals with nosocomlal ventilator-associated pneumonia caused by gram-positive cocci in full-term and preterm newborns and with a trial of the clinical and microbiological efficacy of the antibiotic vancomycin. Thirteen full-term neonates and 46 preterm ones were examined. Most newborn infants (78—93%) were found to have monoinfection caused by gram-positive cocci, mainly Staphylococcus spp. and Enterococcus faecalis. Vancomycin was highly effective against the coccal microflora with the minimum inhibitory concentration (MIC) of <2 ug/ml against Staphylococcus spp. and Group В Streptococcus in 46 newborns, moderately effective with the MIC of 24 ug/ml, but s8 ug/ml against Enterococcus faecalis m9 infants and ineffective or lowly effective with the MIC of 216 ug/ml against Enterococcus faecium in 4 infants. However, secondary infection caused by the hospital strains of gram-negative microorganisms (predominantly Enterobacteriaceae and Pseudomonasaeruginosae) generally inducing mixed infection occurred in 41% of the infants on 5—7 day of the disease. In this connection, most children were given vancomycin in combination with beta-lactam antibiotics or amikacin.
About the Authors
M. V. Kushnareva
Research Clinical Institute of Pediatrics; Maternity Hospital Fifteen, Moscow
Russian Federation
Russian Federation
G. M. Dementyeva
Research Clinical Institute of Pediatrics; Maternity Hospital Fifteen, Moscow
Russian Federation
Russian Federation
A. Yu. Gerasimov
Research Clinical Institute of Pediatrics; Maternity Hospital Fifteen, Moscow
Russian Federation
Russian Federation
References
1. Суханова Л.П., Бушмелева Н.Н., Сорокина З.Х. Младенческая смертность в России с позиций достоверности ее регистрации. Электронный научный журнал «Социальные аспекты здоровья населения» 2013; http://vestnik.mednet. ru/content/view/441/30/ (Suhanova L.P., BushmelevaN.N., Sorokina Z.H. Infant mortality in Russia with position of the believability of the her registration. Electronic scientific journal «Sotsial'nye aspekty zdorov'ya naseleniya» 2013; http://vestnik.mednet.ru/content/view/441/30/)
2. The World Health Report. Make every mother and child count. WHO 2005; 229.
3. Мархулия Х.М., Кушнарееа М.В., Дементьева Г.М. и др. Этиология ИВЛ-ассоциированных пневмоний у недоношенных новорожденных. Педиатрия 2005; 3: 36—39. (Marhulija H.M., Kushnareva M.V., Dementjeva G.M. et al. Etiology of neonatal ventilator-associated pneumonia. Pediatriya2005; 3: 36—39.)
4. Дементьева Т.М., Кушнарееа М.В., Фролова М.И. и др. Антибактериальное лечение госпитальной пневмонии у недоношенных новорожденных детей. Вестн педиат фармакол и нутрициол 2006; 5: 38—42. (Dementjeva G.M., Kushnareva M.V., Frolova M.I. et al. Antibacterial treatment of nosocomial pneumonia in premature infants. Vestn pediat farmakol i nutritsiol 2006; 5: 38—42.)
5. Committee on Infectious Diseases of the American Academy of Pediatrics — AAP — Releases New Principles for URI Antibiotics. Pediatrics 2013; 132: 1146—1154.
6. Nandyal R.R. Update on group В streptococcal infections: perinatal and neonatal periods. J Perinat Neonatal Nurs 2008; 22: 3: 230-237.
7. Schelonka R.L., Scruggs S., Nichols К et al. Sustained reductions in neonatal nosocomial infections rates follouing a comprehensive infection control intervention. J Perinatal 2006; 26: 176-169.
8. Stroll B.J. The Global Impact of Neonatal Infection. Clinics in Perinatology 2006; 24: 1: 1—21.
9. lingerer R. L. S., Lincetto O., McGuire W. et al. Prophylactic versus selective antibiotics for term newborn infants of mothers with risk factors for neonatal infection. In: The Cochrane Library2010;2:24.
10. Руководство по фармакотерапии в педиатрии и детской хирургии. Раздел «Неонатология». Под ред. А.Д. Царего-родцева, В.А. Таболина. М: Медпрактика 2004; 169—170. (Guide to pharmacotherapy in Pediatrics and pediatric surgery. Eds A.D. Zaregorodcev, V.A.Tobolin. Moscow: Medpraktika 2004; 169-170.)
11. Брико Н.И., Ещина А.С., Филатов Н.Н. и др. Микробиологическая диагностика стрептококковых инфекций. Методические рекомендации. М 1996; 31. (Brico N.I., Eshina A.S., Filatov N.N. et al. Microbiological diagnosis of streptococcal infections. Methodical recommendations. Moscow 1996; 31.)
12. Об унификации микробиологических (бактериологических) методов исследования, применяемых в КДЛ лечебно-профилактических учреждений. Приказ №535 от 22.04.1985 Министерства здравоохранения СССР. 1985; 126. (About the unification of microbiological (bacteriological) methods used in clinicodiagnostic laboratories of treatment — and-prophylactic establishments. Order №535 from 22.04.1985 the Ministry of health of the USSR. 1985; 126.)
13. Определение чувствительности микроорганизмов к антибактериальным препаратам. Методические указания. МУК 4.2.1890-04. Утверждены 4 марта 2004 г http://www.bestpravo. ru/rossijskoje/jm-gosudarstvo/y6b.htm (To determine the sensitivity of microorganisms to antimicrobial agents. Methodical instructions. MUK 4.2.1890-04. Approved March 4,2004. http:// www.bestpravo.ru/rossijskoje/jm-gosudarstvo/y6b.htm)
14. Навашин С.Н., Фомина И.П. Рациональная антибиоти-котерапия. Справочник. М 1982; 496. (Navashin S.N., Fomina I.P. Rational pharmacotherapy. Handbook. Moscow 1982; 496.)
Review
For citations:
Kushnareva M.V., Dementyeva G.M., Gerasimov A.Yu. The clinical and microbiological efficacy of vancomycin in the combination treatment of newborns with ventilator-associated pneumonia caused by gram-positive cocci. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2014;59(2):71-77. (In Russ.)
Views:
804
Email this article 