Severe pneumonia in clinical practice

Abstract

Severe pneumonia is the actual problem of present respiratory medicine due to the pronounced impact on mortality and economic expenses of health care. For this reason the aim was to study the regional predictors of fatal severe pneumonia with subsequent development of guidelines for optimizing various aspects of diagnosis and treatment of these group of patients. Retrospective analysis of 62 case histories of admitted patients, who died from severe pneumonia during the calendar year, was performed. The results showed that lethal outcomes of severe pneumonia mostly occur in intensive care units. Analysis of performed laboratory and instrumental diagnostic procedures was conducted to reveal the most significant prognosis markers. The main mistakes in administering medications, firstly antimicrobial, were analyzed. Antibiotic therapy was proclaimed completely optimal only in 18% of cases. The analysis allows to make conclusions about the need for rational minimization of diagnostic complex for hospitalized patients with severe pneumonia with mandatory measurement of oxygen saturation, sputum study and chest X-ray in two projections directly on the first day. Along with timely correction of treatment these methods will allow optimizing the total cost of treatment. Ceftriaxone is a leading administered drug in severe pneumonia with lethal outcomes. Appearingly, first of all, it is determined by the absolute predominance of cheap generic drug forms in pharmaceutical market which do not provide adequate clinical efficiency. Underrated high potential of semisynthetic aminopenicillins in severe pneumonia treatment was identified.

Keywords

severe pneumonia / risk factors / diagnosis / treatment / prognosis

References

[1] Авдеев С.Н. Аспирационная пневмония. Клин. микробиол. и антимикробн. химиотерап. 2008; 10 (3): 216-234.

[2] Вафин А.Ю., Визель А.А., Шерпутовский В.Г. и др. Заболевания органов дыхания в Республике Татарстан: многолетний эпидемиологический анализ. Вестн. соврем. клин. мед. 2016; 9 (1): 24-31.

[3] Дворецкий Л.И. Внебольничная пневмония: диагностика и антибактериальная терапия. Consil. Med. 2006; 8 (3): 25-30.

[4] Зайцев А.А., Синопальников А.И. «Трудная пневмония»: вопросы дифференциальной диагностики. Военно-мед. ж. 2015; 336 (5): 21-28.

[5] Лычев В.Г., Клестер Е.Б. Пневмония в геронтологической практике - пневмония, связанная с оказанием медицинской помощи. Клин. геронтол. 2013; 19 (7-8): 26-30.

[6] Хамитов Р.Ф., Малова А.А., Григорьева И.В. Лечение внебольничных пневмоний: предикторы летальных исходов. Казанский мед. ж. 2014; (3): 356-361.

[7] Хамитов Р.Ф. Внебольничные пневмонии: немедикаментозные факторы риска летальных исходов. Пульмонология. 2014; (1): 23-26.

[8] Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Клинические рекомендации по диагностике, лечению и профилактике тяжёлой внебольничной пневмонии у взрослых. Российское респираторное общество (РРО), Межрегиональная ассоциация по клинической микробиологии и антимикробной химиотерапии (МАКМАХ). 2014; 82 с.

[9] Чучалин А.Г. Пневмонии: актуальная проблема XXI века. Терап. арх. 2016; 88 (3): 4-12.

[10] Quan T.P., Fawcett N.J., Wrightson J.M. et al. Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998-2014. Thorax. 2016; 71 (6): 535-542. http://dx.doi.org/10.1136/thoraxjnl-2015-207688

[11] Welte T. Respiratory epidemiology: ERS monograph Ed. 2. Eur. Respir. Society. 2014; 62-78, 116-124.

[12] Woodhead M. Pneumonia. In: ERS Handbook: Respiratory medicine. Ed. P. Palange, A.K. Simonds. 2-nd edition. Sheffield, European Respiratory Soc. 2013; 199-202. http://dx.doi.org/10.1183/9781849840415.010312

[13] Woodhead M., Aliyu S., Ashton С. et al. Pneumonia. Diagnosis and management of community- and hospital-acquired pneumonia in adults. NICE clinical guideline. 2014; 27 р.

RIGHTS & PERMISSIONS

Khamitov R.F., Pal’mova L.Y., Sulbaeva K.R.