Opasnosti nekritične primjene antibiotika kod novorođenčadi

master's thesis

• Title (english): Risk of inappropriate use of antibiotics in newborn
• Author: Ivor Jelavić
• Mentor: Boris Filipović-Grčić (mentor)
• Committee member: Mirta Starčević (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Boris Filipović-Grčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2021-09-02, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Antibiotici su danas nedvojbeno najkorišteniji lijekovi u jedinicama za intenzivno liječenje novorođenčadi (NICU). Primarni razlog primjene antibiotika kod novorođenčadi je liječenje i prevencija novorođenačke sepse. Novorođenačka sepsa dijeli se na ranu i na kasnu, tako da se čimbenici koji pogoduju nastanku kao i uzročnici ove dvije vrste sepse razlikuju. Nedonoščad spada u posebno rizičnu skupinu kada je u pitanju razvoj sepse. Značajan problem leži u ispravnom postavljanju dijagnoze zbog nespecifičnosti kliničke slike. Danas su najkorištenije dijagnostičke metode za dijagnozu sepse kompletna krvna slika, CRP (C-reaktivni protein), prokalcitonin, hemokulture dok se neke novije metode presepsin, PCR (polymerase chain reaction) još istražuju. Ampicilin i gentamicin danas su najčešće propisivani antibiotici u NICU. Propisivanje antibiotika vrlo je varijabilno te se razlikuje od ustanove do ustanove. U kriterije za započinjanje terapije spadaju evaluacija čimbenika rizika za razvoj sepse koji čine klinički znakovi, porođajna masa, stupanj prematuriteta, kolonizacija majke streptokokom grupe B (GBS), trajanje rupture plodovih ovoja te intrapartalna antibiotička profilaksa majke. Terapija se u pravilu prekida nakon laboratorijskog praćenja smirivanja upalnih parametara. Štetne posljedice neadekvatnog korištenja antibiotika najoportunije bi bilo podijeliti na neposredne i odgođene. Vjeruje se da većina štetnih posljedica antibiotske terapije proizlazi iz njihovog učinka na razvoj fiziološke flore. U neposredne posljedice spada stvaranje rezistentnih sojeva, povećani rizik za razvoj nekrotizirajućeg enterokolitisa, bronhopulmonalne displazije, retinopatije pa čak i povećana smrtnost. Pod odgođene štetne posljedice misli se napose na poremećaje u dobivanju tjelesne mase i astmu. Programi pojačanog nadzora nad ordiniranjem antibiotika i naglašavanje važnosti dojenja otvaraju mogućnost za smanjenje izlaganja novorođenčadi štetnim učincima antibiotske terapije.

Abstract (english)

Antibiotics are clearly most prescribed drugs in neonatal intensive care units (NICU) today. The primary reason behind antibiotic use is the treatment and prevention of sepsis in infants. Sepsis in infants is divided into two categories - early onset sepsis (EOS) and late onset sepsis (LOS), and there exists a difference in terms of the risk factors and the causative agents related to these two sepsis groups. Preterm infants show especially high risk for development of sepsis. Correctly diagnosing sepsis is a relevant issue due to the unspecificity of its clinical signs. The most commonly used diagnostic methods currently include complete blood count, CRP (C-reactice protein), procalcitonin and hemocultures while some less common methods such as presepsin and PCR (polymerase chain reaction) are also being reserached. Ampicilin and gentamicin are the most commonly prescribed antibiotics in NICUs. Antibiotic prescription is very variable and it differs from medical institution to medical institution. Criteria used for assessing whether to commence antibiotic therapy include evaluation of risk factors which consist of: clinical presentation, weight at birth, degree of prematurity, group B streptococci (GBS) colonisation of the mother, duration of membrane rupture and maternal intrapartal antibiotic prophylaxis. The treatment is generally discontinued after laboratory results demonstrate a calming of inflammation markers. Harmful effects of antibiotics are best divided into those that are immediate and those that are delayed. It is belived that the majority of the harmful consequences of antibiotic treatment comes from their effect on the development of physiological flora. Antimicrobial resistance, increased risk of necrotising enterocolitis (NEC), bronchopulmonary dysplasia, retinopathy and even increased mortality all fall under immediate consequences of antibiotic overtreatment. The most important delayed consequences are the disruption of normal weight gain and asthma. Antibiotic stewardship programs and emphasizing the role of breastfeeding are considered to be important for the decrease of newborn infant exposure to the harmful effects of antibiotic treatment.

• Keywords: antibiotici; sepsa; dijagnostika; štetne posljedice
• Keywords (english): antibiotics; sepsis; diagnostic; harmful effects
• Language: croatian
• URN:NBN: urn:nbn:hr:105:560551
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-23 08:30:20