Clinical features of the course of localized and generalized bacterial infections in children
Background. Sepsis continues to be one of the most urgent problems of our time, as there is a tendency to an increase in the incidence and consistently high mortality. Objective: to study the clinical features of the course of bacterial infections in children. Materials and methods. 115 children with generalized and localized forms of bacterial infection were examined. The main group (47 children) — children with sepsis, the comparison group (68 children) — with a localized bacterial infection. Age of children was from 1 month to 18 years. Distribution to groups was carried out by the presence of signs of systemic inflammation response syndrome (SIRS) and organ dysfunction. Results. The study found that the level and duration of the main symptoms of SIRS (hyperthermia, tachycardia and tachypnoe) were statistically significantly higher in the sepsis group. With increasing signs of SIRS and the development of septic shock, the duration and severity of the clinical signs of SIRS increased in direct proportion. Tachycardia almost always (93 %) accompanies the development of sepsis, while localized bacterial infections occur in only a third of children. 40 % of children with sepsis require oxygen therapy. Signs of SIRS are greater in children with localization of the bacterial focus in the ENT and chest cavity, while with central nervous system infection, they passed most quickly. In inotropic support, children with a primary outbreak in ENT were most in need — 44.4 % of cases, children with localization of the focus of bacterial infection in the abdominal cavity did not demand it at all. The average length of stay in the department of intensive care in the children of the comparison group was 5.14 days (95% confidence interval (CI) 4.42–5.87), and in children of the main group — 13.1 days (95% CI 9.16–17), which was 2.5 times higher (p < 0.01). Conclusions. The indicator and duration of the main manifestations of SIRS (hyperthermia, tachycardia, tachypnea) are statistically significantly higher in children with sepsis, and they proportionally increase with an increase in the number of signs of SIRS. The main indicators of SIRS in children with sepsis with 2 symptoms of SIRS are observed for a long time, and their level is statistically lower in comparison with children with 3 or more signs of SIRS. In 75 % of children with localized bacterial infection, there is a short breathing, although its duration is negligible and they do not require oxygen therapy, while slightly fewer children with sepsis require the latter.
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