HEALTH CARE-ASSOCIATED PNEUMONIA: CLINICAL AND ROENTGENOLOGIC HARACTERSTICS, TREATMENT OPTIMIZATION

Abstract

Clinical and roentgenologic features of health care-associated pneumonia have been studied. Within the therapeutics department thorough clinical and roentgenologic examinations of 309 patients with pneumonia diagnosed according to Russian National Recommendations on out-patients pneumonia (2010) were done. The criterion of exclusion was the nosocomial pneumonia. Health care-associated pneumonia was diagnosed in 86 (27.8%) patients, more than a half of them (52.3%) were old people (64-74 years old). Gender differences were statistically non-significant. From the anamnesis it was found out that 50 patients took antibacterial drugs for 5.9±1.5 days on average during 30 days preceding hospitalization due to the exacerbation of chronic inflammatory diseases; 33 patients were at the inpatient treatment for more than two days during 90 preceding days. In the majority of patients (68.6%) clinical symptoms of pneumonia were blurred and disguised under the main disease clinic, intensive respiratory and heart failure. While defining the severity of pneumonia by CURB-65 scale, II points were found in 40.7% patients, III and more points in 25.6%. Double pneumonia was found in 40.7% patients, multilobular damages were in 22.1%. Exudative pleurisy (25.6%) and lung tissue destruction (7.0%) were the most often complications. Because of ineffective initial empiric antibacterial therapy (semisynthetic penicillins, macrolides), intravenous induction of respiratory fluroquinolones in the combination with ceftriaxone (61.1%) and macrolides (12.8%) was administered further on. The mid duration of inpatient treatment was 17.6±3.9 days. 3 patients died. Thus health care-associated pneumonia is a new category of pneumonia which is diagnosed in every third patient who comes to get the inpatient treatment further with diagnosed pneumonia. A severe course of the disease refers to the clinical features of the disease, double affection and frequent complications refer to roentgenologic ones. A more severe course of the disease should lead to an increased attention to this category of patients and proper antibacterial therapy. Besides, the patients with health care-associated pneumonia were registered to have a longer period of hospitalization.