Community-acquired pneumonia in hospitalized patients: clinical guidelines

Abstract

Community-acquired pneumonia is still the cornerstone of practical public health care due to high morbidity and mortality. Streptococcus pneumoniae (30-50%), Haemophilus influenzae, Staphylococcus aureus and Klebsiella pneumoniae remain the main cause of community-acquired pneumonia (3-5%). In recent years, the spread of strains resistant to macrolide antibiotics (~30:) and isolates with reduced sensitivity to β-lactams among pneumococci has been a topical problem. On the pages of international recommendations, biological markers of inflammatory response are of great importance in the diagnosis of community-acquired pneumonia. Thus, in patients with an uncertain diagnosis of «community-acquired pneumonia» in case of concentration of C-reactive protein ≥ 100 mg/l its specificity in confirming the diagnosis exceeds 90%, at a concentration of < 20 mg/l the diagnosis of pneumonia is unlikely. All hospitalized patients with community-acquired pneumonia should use the IDSA/ATS criteria or SMART-COP scale to assess severity, predict and determine admission to intensive  care  unit. When planning antimicrobial therapy tactics in hospitalized patients, it is advisable to categorize patients taking into account risk factors for ineffective therapy. In the absence of such, choice of antibiotics are inhibitor-proof aminopenicillins (amoxicillin/clavulanate, etc.), ampicillin; the alternative therapy mode involves the use of respiratory fluoroquinolones.In patients with comorbidities and other risk factors for infection with resistant microorganisms, the drugs of choice are inhibitorproof aminopenicillins (amoxicillin/clavulanate, etc.), III generation cephalosporins (cefotaxime, ceftriaxone), respiratory fluoroquinolones, and ceftaroline and ertapenem may be used in certain categories of patients. With regard to ceftaroline, it is worth noting that its use is currently an attractive strategy due to its wide range of activities, including resistant strains of pneumococcus and S. aureus. Special attention in the publication is paid to antimicrobial therapy modes in case of severe community-acquired pneumonia, the criteria of efficacy assessment and duration of antibiotics application are reflected.