Open AccessEffectiveness of antimicrobial therapy for community-acquired pneumonia in real clinical practice
Author(s) -
Oleg Uryasev,
А. В. Шаханов,
L. V. Korshunova
Publication year - 2022
Publication title -
bûlletenʹ sibirskoj mediciny
Language(s) - English
Resource type - Journals
eISSN - 1819-3684
pISSN - 1682-0363
DOI - 10.20538/1682-0363-2021-4-79-85
Subject(s) - medicine , community acquired pneumonia , azithromycin , levofloxacin , pneumonia , ceftriaxone , regimen , antimicrobial , empiric therapy , odds ratio , combination therapy , intensive care medicine , antibiotics , surgery , chemistry , alternative medicine , organic chemistry , pathology , microbiology and biotechnology , biology
Background . Community-acquired pneumonia (CAP) remains one of the most common infectious diseases, occupying an important place in the structure of mortality worldwide. Aim . To evaluate the effectiveness of antimicrobial therapy for community-acquired pneumonia in hospitalized patients in real clinical practice. Materials and methods . A retrospective, observational study was conducted, which included 236 patients hospitalized for community-acquired pneumonia at the Regional Clinical Hospital in Ryazan in 2019. Based on these case histories, an analysis of the effectiveness of the initial empiric antimicrobial therapy was performed. Results . The initial empiric antimicrobial therapy in 73% of cases included administration of ceftriaxone, in 45% of cases – levofloxacin, in 14% of cases – azithromycin. It was found that initial antimicrobial therapy was effective in 58% of patients who did not require replacement for the antibiotic. A need for a change in the treatment regimen was significantly associated with an increase in the length of hospitalization (p < 0.001), heart rate upon admission (p = 0.032), myelocyte count in the complete blood count (p < 0.001), and urea and blood creatinine levels (p = 0.004 and p = 0.044, respectively). The selected antimicrobial therapy regimen was significantly associated with the expected treatment effectiveness (p = 0.039). The choice of levofloxacin in monotherapy or in combination with ceftriaxone was accompanied by a decrease in the relative risk of replacing the antimicrobial, compared with other treatment regimens (odds ratio (OR) = 0.86 (95% confidence interval (CI): 0.55–1.34) and OR = 0.57 (95% CI: 0.37–0.87), respectively). Conclusion . Empiric antimicrobial therapy for community-acquired pneumonia in real clinical practice complies with current recommendations, however, at the same time, its ineffectiveness persists. Respiratory fluoroquinolones are most effective in treating pneumonia in hospitalized patients.