Factors influencing the choice of antibiotic therapy regimen for pleural empyema

There are considered the factors affecting the choice of an antibacterial drug for antibacterial therapy, based on the analysis of the material. The analysis of these factors was provided. The most problematic pathogens of pleural empyema are non-fermenting gram-negative bacteria: P. aeruginosa, Acinetobacter spp.; Еnterobacteriales: K. pneumoniae, Escherichia coli, Enterobacter spp., Proteus spp.; gram-positive cocci: Staphylococcus spp., Streptococcus spp., Enterococcus spp.; anaerobic bacteria: Bacteroides spp., Clostridium spp., Fusobacterium spp., Peptococcus spp., Peptostreptococcus spp. Most authors note an increase of antibiotic resistance in pathogens of pleural empyema, which significantly complicate the choice of antibacterial therapy. It was revealed that the choice of drug for antimicrobial therapy should be justified on the basis of a systemic, integrated approach taking into account the etiology of the pleural empyema, the severity of the patient and concomitant pathology. The main factors influencing the choice of antibacterial drug are the origin of pleural empyema (in-hospital or out-of-hospital), the presence of previous admissions, the previously provided antibacterial therapy and the results of stratification of patients by the risk of polyresistant microflora. With the appearance of clinical signs of the in-hospital pleural empyema the choice of antibacterial drug for antimicrobial therapy should be made taking into account clinical and epidemiological data and the results of microbiological monitoring in the hospital.