Chronic critical patient in pediatrics: microbiological “portrait” and problems of antibiotic resistance

Abstract

Patients who have experienced acute critical condition and realized the “syndrome of the consequences of intensive care” become “chronic critical patients” and need long-term maintenance of vital functions of the body for many months and even years. The progressive development of resuscitation care with the improvement of respiratory and nutritional support, the introduction of new drugs and the development of modern algorithms for the treatment of critical conditions in children led to an improvement in survival rates among patients in intensive care units. At the same time, not all surviving patients end the trajectory of the disease by recovery and some children remain dependent on one or another type of protection of the function of organs and systems. There are conditions that require long-term maintenance of the body in a hospital: in the intensive care unit, in the PIT or in the palliative care unit. Prolonged invasive effects, aggressive nosocomial microbiota, immunodeficiency conditions lead to permanent contamination and the formation of infection loci. Periodically relapses, reactivations of bacterial inflammation are of a specific nature inherent in a chronic critical patient. Therapy of these exacerbations is complex and should be carried out taking into account the peculiarities of this category of patients. For the prevention of chronic critical condition, microbiological monitoring should be carried out taking into account the sensitivity to antibiotics in order to timely antibacterial therapy, and in some cases, antibiotic prophylaxis. The authors of the present review consider in detail the problem of microbial colonization in a chronic critical child on the example of various pathological conditions occurring with the formation of chronic lung disease. These issues should be considered by doctors of different levels of medical care in routine practice.