Community-acquired pneumonia treatment: predictors of fatal outcomes

Aim. To analyze the quality of the medical aid in cases of community-acquired pneumonia with fatal outcomes and further development of recommendations for optimizing treatment strategy and tactics. Methods. Retrospective analysis of 62 medical charts of in-patients who passed away from community-acquired pneumonia during the calendar year. Results. The major part of all fatal outcomes of community-acquired pneumonia were seen at the intensive care units, to which the majority of such patients (41 cases, 66.1%) were admitted right from the admission ward. Differences of treatment tactics in patients with community-acquired pneumonia were revealed depending on the department type (internal diseases, intensive care unit, pulmonology) where the patients were admitted. The treatment manipulations structure and common mistakes made in administrating antibacterial and non-anti-infective drugs in cases of community-acquired pneumonia with fatal outcomes were analyzed. Anti-microbial treatment was assessed as completely adequate only in 18% of cases. In cases of severe community-acquired pneumonia with fatal outcomes the most commonly administered antibacterial drug was ceftriaxone (41 cases, 66.1%). At the same time, the potential of semisynthetic aminopenicillins was not unlocked (only 9 cases, 14.5%). The most common contraventions of rational anti-microbial treatment principles were irrational combinations, inadequate daily dosage and antimicrobial treatment change sequence. A trend for inappropriate administration of corticosteroids in patients with severe and extremely severe community-acquired pneumonia in the intensive care units was observed. The use of other non-anti-infective drugs (anticoagulants, diuretics, mucolytic agents and bronchodilators) as components of complex treatment in patinets with life-threatening community-acquired pneumonia should be strictly limited by their indications for use. Conclusion. Rational anti-bacterial treatment performed in compliance with national recommendations (2010) is the cornerstone of treating community-acquired pneumonia.

community-acquired pneumonia, risk factors, treatment, fatal outcomes