[The influence of the initial antibacterial treatment effectiveness, clinical and etiological factors on non-resolvent severe pneumonia and outcome].
OBJECTIVE
To evaluate the influence of the initial pneumonia treatment effectiveness, clinical and etiological factors, local innate immune response intensity on pneumonia non-resolution and mortality.


METHODS
One hundred one bronchoscopy and bronchoalveolar lavage performed to 68 severe community (CAP) or hospital-acquired pneumonia patients survived during initial 5-7-day treatment period. Initial treatment effectiveness, age, pneumonia type, presence of mechanical ventilation, comorbidities, coma, antibacterial treatment, pathogen isolation and treatment changes were assessed. Logistic regression analysis was performed to detect factors associated with non-resolving pneumonia and mortality.


RESULTS
Etiotropical treatment was administered to 30.9% of patients. Initial antibacterial treatment was corrected in 64.7% of all cases. After 21-30 days from the pneumonia onset survived 66.2% of patients (n=43). Pneumonia course could be evaluated in 52 cases. Delayed resolution of the pneumonia was stated in 32.7% of cases (n=17). Pneumonia was cured or condition improved in 64.3% of the CAP patients (n=9) and 68.4% of the hospital-acquired pneumonia patients (n=26). Only ineffective initial pneumonia treatment significantly increased probability of non-resolving pneumonia on multivariate analysis (OR 16.92, 95% CI 2.02-141.72, p<0.05). Influence of etiotropic treatment was not significant. Isolation of two or more pathogens from bronchoalveolar lavage fluid after the initial treatment was significantly associated with mortality on multivariate analysis (OR 6.25, CI 1.06-36.74, p<0.05). The other analyzed variables had no significant influence on pneumonia resolution and outcome. In conclusion, the initial pneumonia treatment failure increases probability of the non-resolving pneumonia. Etiotropical treatment has no impact on pneumonia outcome when adequate empirical antibacterial treatment is administered, however, it allows to reduce unnecessary use of the broad-spectrum antibacterials. Mortality is associated with the presence of the polymicrobial infection after the initial pneumonia treatment.
Dudzevicius
Vytis
V
Department of Pulmonology and Allergology, Kaunas University of Medicine Hospital, Lithuania.
Vitkauskiene
Astra
A
Sakalauskas
Raimundas
R
D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D013902:Radiography, Thoracic; D012121:Respiration, Artificial; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Pradinio antibakterinio gydymo veiksmingumo, klinikiniu bei etiologiniu veiksniu itaka uzsitesusiai sunkios pneumonijos eigai ir baigciai.