Staphylococcal infection

Staphylococcal infection . At present, as a result of widespread use of antibiotics, and sometimes abuse of them, the problem of dysbacteriosis-the most important pathogenetic factor in the activation of staphylococcus, salmonella, Escherichia coli and other opportunistic flora, has arisen.

Staphylococcal diseases affect mainly young children or children weakened by other diseases. This feature is related to the properties of the pathogen as a conditionally pathogenic microbe and makes it necessary to focus attention on the reactivity of children. The main cause of staphylococcal infection is a violation of the mechanisms of natural resistance and pathology of local immunity, since in the formation of autoflora the leading role is played by specific and local immunological reactions of the organism.

Up to 80% of pathogenic strains isolated from healthy individuals are resistant to one or more antibiotics. Staphylococci, isolated from patients and staff, are usually characterized by multiple resistance, often to 6-8 antibiotics. Therefore, the use of antibiotics for preventive purposes does not protect against purulent-septic diseases, and these drugs, being immunosuppressant and reducing the defenses of the organism, contribute to the colonization of hospital strains of microbes that are characterized not only by high virulence, but also by invasiveness. Limiting the use of antibiotics with strict indications can lead to a decrease in the antibiotic resistance of staphylococci.

Significant role in the spread of staphylococcal infection is played by carriers of pathogenic staphylococcus. The carriage of staphylococci is characterized by a wide spread among both healthy and especially among sick people. The form of carrier can be different. There is a category of people who regularly have staphylococci of the same serotype. This, apparently, is the true carriers. Less dangerous are carriers of different types of staphylococci, although the latter are also found constantly. Distinguished carriers temporary and unstable.

The clinical course of staphylococcal infection is characterized by a variety - from severe, generalized forms to the lungs: sepsis, pneumonia, meningitis, abscesses of internal organs, enterocolitis, endocarditis, gynecological diseases, staphylococcal infection with scarlatina-like syndrome, purulent inflammatory diseases of the skin and soft tissues, etc. Often In such cases, the disease is mixed etiology. In addition to staphylococcus, Salmonella, intestinal, Pseudomonas aeruginosa or streptococcus, pneumococcus, etc. are sown. With microbial associations, the course of the disease is characterized by a special severity.

The peculiarity of the course of staphylococcal infection in children is the propensity to generalize the process. The incidence of sepsis among newborns is greatest (see).

It is established that staphylococci in 48-78% of cases are the cause of acute respiratory tract infections. Staphylococcal pneumonia occurs either as an independent form of the disease (rarely), or as one of the syndromes of staphylococcal infection, or combined with other infectious diseases, more often viral etiology. In some cases with staphylococcal pneumonia, staphylococcus is sown in association with intestinal, Pseudomonas aeruginosa, with vulgar proteome, with fungi of the genus Candida, streptococcus.

With staphylococcal pneumonia, as well as with other forms of staphylococcal infection, it is often possible to establish an epidemiological connection with pyoderma, other small forms of staphylococcal infection; Infection is often associated with family contact (mastitis, angina), nosocomial infection in maternity hospitals, children's hospitals. The pulmonary form of staphylococcal infection is characterized primarily by the polysegmentary nature of the lesion with rapid, often lightning, development of destruction of lung tissue complicated by pneumothorax.

Destruction of the lungs is staphylococcal. At present, it is quite common in connection with the increase in the value of staphylococcus in the pathology of childhood. In the development of staphylococcal pneumonia, both the bronchogenic pathway of infection (during epidemics and sporadic cases of acute respiratory infections) and the hematogenous pathway of the lungs are important as the infection comes from other foci, but the bronchogenic pathway does not exclude hematogenous pathway.

Biological specificity of staphylococcus is determined by toxins released into the environment (lethal toxin, leukocidin, gemotoxin or staphylolysin, necrotoxin, entertoxin, etc.) and enzymes (coagulase, hyaluronidase, penicillinase, etc.). In the development of staphylococcal destruction, the leading role belongs to necroxotinum and hyaluronidase, in which the foci of necrosis very quickly appear in the lung tissue (small atelectasis is formed in some regions of the lungs), the decay cavities are formed - "staphylococcal bullae" (from 0.5 to 2-3 cm in Diameter) and conditions are created for spreading the infection to the pleura (fibrinous-purulent overlap). On the one hand, this highlights the "pleural" symptomatology (pyopneuromotorax, total empyema), and on the other, causes severe intoxication of the body, causes deep functional disorders of respiration and circulation, also associated with the acute development of "stress syndrome" in the thoracic cavity.

For primary staphylococcal pneumonia, one-sided localization of the process with frequent and fairly rapid (almost simultaneous) involvement in the pathological process of the pleura is more characteristic. The development of secondary staphylococcal pneumonia (these forms are less common than primary) is due to the generalization of purulent infection in the body (osteomyelitis, otitis, pyoderma, etc.) more slowly and gradually.

Primary staphylococcal pneumonia initially differs little from acute pneumonia of another etiology, however, the development of the disease often acquires a rapid character. The lightning-fast course of the process sometimes gives reason to suppose in patients the appearance of an acute abdomen (intussusception, appendicitis, etc.). There is a rapid increase in intoxication, manifestations of which can be hyperthermia (39-40 g C and above, a hectic type curve), cardiovascular and respiratory failure (acrocyanosis even at rest, shortness of breath, cyanosis of the mucous membranes and skin). Children are restless, rush into bed, periodically moan, sometimes cry; Sweating, chills, injected sclera, puffiness of the face, hyperemia of the cheeks (mainly on the side of the lesion), occasional bouts of excruciating dry (less often wet) cough. It is possible to break the contents of one of the stressed bullae into the pleural cavity; As a result, the already serious condition of the child catastrophically worsens, cyanosis develops sharply, cold sticky sweat appears, dyspnea reaches 80 in 1 min, tachycardia - 170-180 in 1 min, the pulse becomes filamentous, a collapoid state arises. Less often the symptoms of purulent pleurisy grow gradually. The affected half of the chest loses its aspiration, percussion determines the shortening of the percussion tone up to absolute stupidity; At auscultation, in contrast to adults, the ball is determined by breathing, and with a bronchial shade, and the smaller the child, the more such options are often (thin chest, pre-pinched lung). Above bulls, breathing has an amphoric tinge, various wet rales are heard. Typically, the displacement of the mediastinal organs in a healthy way, especially in patients with valve pneumo- or pyopneumothorax. A special threat to life is the displacement and constriction of the main veins.

A large, sometimes crucial in the diagnosis of staphylococcal destruction of lungs has a dynamic radiographic study. Initially, the lungs show multiple dense shadows within several segments, one or two lobes of the lung, on the 2nd-5th day, round enlightenments of different size begin to appear with and without the level (dry bulbs) around which the infiltration of lung tissue . Signs of a lesion of a pleura with accumulation in its cavity of pus or air or that and another together are revealed also. Therefore, one of the most important diagnostic studies, along with X-ray, is the puncture of the pleural cavity.

With indications, bronchography, tomography, pleurography, angiopneumogram, radioisotope examination of the lungs, diagnostic (also medical) bronchoscopy, thoracoscopy are performed.

Staphylococcal enterocolitis accounts for 4 to 30% of all cases of acute intestinal infection. This is the most serious disease among all intestinal infections. Mortality reaches 13%.

Mostly children of the first half of life with an unfavorable premorbid background (prematurity, hypotrophy, early artificial feeding, transferred diseases, particularly acute respiratory and pseudofurunculosis, repeated administration of antibiotics, other medicines, often mastitis in the mother). In this regard, gastrointestinal diseases of this profile are often considered not only as a result of infectious and toxic effects, but also as a consequence of impaired intestinal biocenosis as a result of reducing the resistance of the organism or the action of antibiotics.

Staphylococcal meningitis in children is characterized by the most severe course. Among all cases of purulent meningitis, meningitis of staphylococcal etiology accounts for 2-3%.

Staphylococcus in modern conditions is often the cause of septic endocarditis (in 67% of cases). It is detected in 95-100% of cases with purulent diseases of soft tissues and skin. Staphylococcus burdens the course of burns, various dermatoses, and for some of them it is considered as an etiologic factor.

Treatment of staphylococcal diseases. The effectiveness of treatment depends on the timely diagnosis and early application of complex specific antistaphylococcal agents. Great importance is the proper care of the child.

Of the antibiotics, aminoglycosides (kanamycin, gentamicin) are most effective at a therapeutic concentration in combination with semisynthetic antibiotics of the penicillin series (methicillin, oxacillin, ampiox, rationally combining the properties of ampicillin and oxacillin, etc.), olemorphocycline, chainin, erythromycin phosphate (intravenously), and Fuzidine, especially in combination with oleandomycin (indications for a combination of antibiotics are now significantly narrowed, since this also shows a negative effect, combined use of them is appropriate only in very severe cases).

Widely used nitrofurans, in particular furagin K (intramuscularly, intravenously and less frequently intraosseous).

Use antimicrobial drugs should be extremely cautious and only in combination with drugs that stimulate protective mechanisms and restore ecological balance.

In the acute period of the disease, means of passive immunization are shown - direct transfusions of donor blood, the introduction of antistaphylococcal plasma, antistaphylococcal (from donor blood), intramuscular immunoglobulin, directed intravenous immunoglobulin. Use inhibitors of proteolysis - kontrikal (trasilol), synthetic agents - ambene and the like. Correction of metabolic disorders, the use of symptomatic means are also necessary. According to the indications (phlegmon, pneumothorax, etc.), immediate surgical intervention is performed.

When the patient's condition is improved, active immunization means are used-staphylococcal anatoxin, autovaccine, staphylococcal bacteriophage. To stimulate immunogenesis, prodigiosan, lysozyme, chlorophyllin is recommended. All this is used in combination with such biologically active substances as lactobacterin, bifikop, bifidobacterin, and also metacil, vitamins.

Prevention of staphylococcal disease in children is not well developed. In order to prevent the spread of infection, a strict role should be played by strict control over the sanitary and epidemic regime of medical and preventive institutions, control over pregnant women, puerperas, newborns: timely detection of small forms of purulent-inflammatory diseases in them and their immediate transfer if pathology is detected from the physiological departments in Wards and even offices with an infectious regime. Of great importance is the centralization of sterilization units in medical institutions.

An important measure aimed at reducing the prevalence of staphylococcal infection is the vaccination of pregnant women with purified adsorbed staphylococcal anatoxin.

Given that most often antibiotic-resistant cultures of staphylococcus are sown from faeces, it is recommended to widely administer bifidobacterin to restore normal intestinal biocenosis: 1) to all premature and small children in maternity hospitals, and later in departments for the pathology of newborns and premature infants during 1-2- Th month of life; 2) children who received antibiotics in the early neonatal period; Newborns breastfed with donor breast milk, or children of mothers with lactostasis, nipple cracking, resumed breastfeeding after mastitis; 3) sick newborns and children of the first year of life (with sepsis, pneumonia, especially intestinal syndrome), especially seriously ill. Abolition of bifidobacterin in sick children should be no earlier than 10-15 days after the end of treatment with antibacterial drugs.

It is important to strengthen control over the use of antibiotics, immunosuppressive therapy.