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Журнал "Клиническая геронтология"

 

ПНЕВМОНИЯ, «НЕ ОТВЕЧАЮЩАЯ НА ЛЕЧЕНИЕ» (Обзор)

А.А. Зайцев1, А.И. Синопальников2

 Главный военный клинический госпиталь им. Н.Н. Бурденко, Российская медицинская академия последипломного образования

1Зайцев Андрей Алексеевич, д-р мед. наук, профессор, начальник пульмонологического отделения ГВКГ им. Н.Н. Бурденко. Тел.: 8(499) 263-10-47. E-mail: a-zaicev@yandex.ru

2Синопальников Александр Игоревич, д-р мед. наук, профессор, зав. кафедрой пульмонологии  РМАПО. Тел.: 8(499) 252-21-04

В клинической практике известно, что почти 18%  пациентов с нетяжелой больничной пневмонией, лечащихся амбулаторно, и в 6-15% госпитализированных больных не отвечают на лечение должным образом. А при тяжелом течении пневмонии состояние пациентов ухудшается в 40% случаев на фоне  адекватной терапии.  Подробно освещены все аспекты этой ситуации , трудной в клиническом и организационном плане.

Ключевые слова:  пневмония, отсутствие эффекта лечения

Литература

  1. Menendez R., Torres A., Zalacain R. et al. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome// Thorax 2004.Vol. 59. С. 960-965.
  2. Mandell L.A., Wunderink R.G., Anzueto A. et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community‑Acquired Pneumonia in Adults. Доступно на: http://www.thoracic.org/sections/publications/statements/pages/mtpi/idsaats-cap.html
  3. Arancibia F., Ewig S., Martinez J.A., et al. Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications // Am. J. Respir. Crit. Care Med. 2000. Vol. 162.P. 154-160.
  4. Menendez R., Torres A., Rodriguez de Castro F., et al. Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients// Clin. Infect. Dis. 2004. Vol. 39. P.1783-1790.
  5. Ewig S., de Roux A., Bauer T., et al. Validation of predictive rules and indices of severity for community acquired pneumonia// Thorax. 2004. Vol.59. P. 421-427.
  6. Roson B., Carratala J., Fernandez-Sabe N., Tubau F., Manresa F., Gudiol F. Causes and factors associated with early failure in hospitalized patients with community-acquired pneumonia // Arch. Intern. Med. 2004. Vol.164. P.502-508.
  7. Menendez R., Torres A. Treatment Failure in Community-Acquired Pneumonia // Chest. 2007. Vol. 4. №132. P.1348-1355.
  8. Menéndez R., Cavalcanti M., Reyes S. Markers of treatment failure in hospitalized community acquired pneumonia. Thorax 2008; 63: 447-452.
  9. Hoogewerf M., Oosterheert J., Hak E. et al. Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia // Clin. Microb. Infect. 2006. Vol. 12. P. 1097-1104.
  10. Schaaf B., Boehmke F., Esnaashari H. et al. Pneumococcal septic shock is associated with the interleukin-10–1082 gene promoter polymorphism. Am. J. Respir. Crit. Care Med. 2003. Vol. 168. P.476-480.
  11. Gallagher P., Lowe G., Fitzgerald T., et al. Association of IL-10 polymorphism with severity of illness in community acquired pneumonia. Thorax 2003; 58,154-156.
  12. Halm E., Fine M., Marrie T. et al. Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines // JAMA. 1998. Vol.279 1452-1457.
  13. Daifuku R., Movahhed H., Fotheringham N. et al. Time to resolution of morbidity: an endpoint for assessing the clinical cure of community-acquired pneumonia // Respir. Med. 1996. Vol.90. P. 587-592.
  14. Fine M., Auble T., Yealy D. et al. A prediction rule to identify low-risk patients with community-acquired pneumonia // New Engl. J. Med. 1997. Vol. P.336: 243-250.
  15. Lim W., van der Eerden M., Laing R. et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study // Thorax. 2003. Vol. 58: P.377-382.
  16. Charles P., Fine M., Ramirez J. et al. Validation of SMART-COP: a pneumoniae severity assessment tool for predicting with patients will need intensive respiratory or inotropic support (IRIS). 47th ICAAC, Chicago, 2007 Abstr.: L1156a.
  17. Чучалин А.Г., Синопальников А.И., Козлов Р.С., и соавт. Внебольничная пневмония у взрослых. Практические рекомендации по диагностике, лечению и профилактике. М., 2010. 82 с.
  18. Houck P., Bratzler D., Nisa W., Ma A., Bartlett J.G. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia // Arch. Intern. Med. 2004. Vol.164. P. 637-644.
  19. Smith R., Lipworth B., Cree I., Spiers E., Winter J. C-reactive protein: a clinical marker in community-acquired pneumonia //  Chest. 1995. Vol. 108. P. 1288-1291.
  20. Boussekey N., Leroy O., Alfandari S. et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia // Intensive Care Med. 2006 Vol. 32. P. 469-472.

                                                                                                           

Pneumonia, "unresponsive to therapy"(Review)

А.А. Zaytsev1, А.I. Sinopalnikov2

 Main Military Clinical Hospital named after NN Burdenko, Moscow,

Russian Medical Academy of Postgraduate Education

1 Zaytsev Andrey Alexeevich, MD, professor, Head of Pulmonology Department of Main Military Clinical Hospital named after NN Burdenko, Moscow.

Теl.: 8(499) 263-56-97. E-mail: a-zaicev@yandex.ru

2 Sinopalnikov Alexandr Igorevich, MD, professor, Head of Pulmonology Department of RMAPO. Тел.: 8(499) 252-21-04

In clinical practice it is known that nearly 18% of patients with non-severe pneumonia hospital, treated with ambulatory treatment and 6-15% of hospitalized patients do not respond to treatment as expected. And in severe pneumonia patients condition deteriorates in 40% of cases in the adequate therapy. Covered in details all aspects of the situation, which is difficult in clinical and organizational terms.

 

Key words: treatment failure in community acquired pneumonia



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