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Pneumonia is an acute infectious disease characterized by focal lesions of the respiratory parts of the lungs with intra-alveolar exudation, detected by objective and x-ray examination, expressed to varying degrees by a febrile reaction and intoxication.
Clinically significant is the division of pneumonia into community-acquired and nosocomial (hospital, nosocomial). This division of pneumonia is in no way associated with the severity of their course. The main and only criterion for distinguishing is the environment in which pneumonia developed.
Nosocomial pneumonia is pneumonia that develops in a patient no earlier than 48 hours after hospitalization and was not in the incubation period.
The main pathogens
Pneumococcus remains the most common causative agent of community-acquired pneumonia (Table 2). Two other microorganisms - M. pneumoniae and C. pneumoniae - are often found in young and middle-aged people (up to 20-30%), and their etiological role in patients of older age groups is less significant (1-3%). L. pneumophila is a rare causative agent of community-acquired pneumonia, but legionella pneumonia is the second largest (after pneumococcal) mortality rate. H.influenzae often causes pneumonia in smokers, as well as in the presence of chronic bronchitis. E. coli and K. pneumoniae (less often other representatives of the Enterobacteriaceae family) are found, as a rule, in patients with risk factors (diabetes mellitus, congestive heart failure, etc.). The likelihood of staphylococcal pneumonia (S.aureus) increases in the elderly or in people with the flu.
Table 2. Etiology of community-acquired pneumonia
In the etiology of nosocomial pneumonia, the gram-negative microflora of the Enterobacteriaceae family, P. aeruginosa predominates (Table 3).
Table 3. Etiology of nosocomial pneumonia
In the treatment of patients with community-acquired pneumonia, the choice of AMP should be differentiated taking into account age, severity of the condition, the presence of concomitant diseases, the patient's location (at home, in the general ward of the hospital, in the ICU), previous antimicrobial therapy, the use of glucocorticoids, etc.
Table 4. Selection of antibiotics for community-acquired pneumonia
When choosing an AMP in a patient with nosocomial pneumonia, the nature of the department in which he is located (general profile or ICU), the use of mechanical ventilation, and the time of development of VAP are taken into account (Table 5). Empirical therapy is planned based on local sensitivity data of probable pathogens. A sputum test is mandatory, while it is desirable to obtain material by invasive methods with a quantitative assessment of the results, and blood culture.
Table 5. Selection of antibiotics for nosocomial pneumonia
Routes of administration of antimicrobial agents
In the treatment of outpatient forms of community-acquired pneumonia, preference should be given to AMP for oral administration. However, in severe infections, AMP must be administered iv. In the latter case, stepwise therapy is also highly effective, which involves a transition from the parenteral to the oral route of administration. The transition should be carried out with the stabilization of the course or improvement of the clinical picture of the disease (on average after 2-3 days from the start of treatment).
With uncomplicated community-acquired pneumonia, antibiotic therapy can be completed when a stable normalization of body temperature is achieved. The duration of treatment is usually 7-10 days.
In the presence of clinical and / or epidemiological data on mycoplasma, chlamydial or Legionella pneumonia, the duration of antibiotic therapy should be longer due to the risk of infection recurrence - 2-3 weeks.
The duration of the use of AMP in complicated community-acquired pneumonia and nosocomial pneumonia is determined individually.
In any case, the preservation of individual clinical, laboratory and / or radiological signs is not an absolute indication for the continuation of antibiotic therapy or its modification. In most cases, the resolution of these signs occurs independently over time.
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