[Current features of antibacterial therapy of nosocomial pneumonia].
OBJECTIVE
To show the role of de-escalation antibacterial therapy (ABT) in the course and outcome of nosocomial pneumonia (NP).


METHODS
A prospective cohort study included 398 NP patients whose clinicomicrobiological parameters and ABT schemes were analysed. In addition, bacteriological study of secretion samples from the lower airways was made. The samples were obtained at endotracheal aspiration (ETA) and bronchoalveolar lavage (BAL).


RESULTS
NP was most frequently caused by methicillin-resistant strains of S.aureus (MRSA) - 14.8%, Pseudomonas aeruginosa - 14.3%, other strain of staphylococcus - 8.8%. Initial ABT employed cefepim (30.4%) or combination of cephalosporines of the third generation with aminoglycosides (27.9%). Most of the patients (61.6%) had no escalation/de-escalation of ABT throughout the treatment. De-escalation therapy achieved lethality reduction from 23.7 to 17.0% and 42.5% vs standard and escalation ABT, respectively (p = 0.001).


CONCLUSIONS
Schemes and regimes of ABT vary depending on population of patients with NP. De-escalation ABT of NP patients reduces lethality.
Baĭgozina
E A
EA
Sovalkin
V I
VI
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D012800:Siberia / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002511:Cephalosporins