The particularities of antibacterial treatment in nosocomial pneumonia in patients with comorbidities
DOI:
https://doi.org/10.52556/2587-3873.2024.4(101).09Keywords:
Nosocomial pneumonia, combination antibiotictherapy, antimicrobial resistance, comorbiditiesAbstract
Nosocomial pneumonia is one of the causes of medical complications and deaths among patients hospitalized in medical institution. The signifi cant use of antibacterials and the causes of failure of antibiotic therapy of nosocomial pneumonia require continuous reevaluation and detailed approach. The study was analytical, retrospective based on 45 medical records of patients with nosocomial pneumonia treated in the „Gheorghe Paladi” Municipal Clinical Hospital. Th e analysis of medical records determined the prevalence of nosocomial pneumonia in the elderly with the predominance of pneumonia associated with specialized medical care. Antibiogram data reported that Gram negative bacteria, including Klebsiella pneumoniae, with a high degree of resistance, were the most frequent causes of nosocomial pneumonia. Antimicrobial therapy in most cases was combined and it achieved by rational synergistic or allowed associations. Cardiovascular, renal and liver diseases were the comorbidities associated with nosocomial pneumonias in hospitalized patients, which, together with the degree of resistance to antimicrobial preparations, constituted an important factor in the selection and prescription of antibacterial treatment. Antibiotic therapy was prescribed according to the national clinical protocol for nosocomial pneumonias. Th e prescription of the combined antimicrobial treatment, respecting the pharmacokinetic and pharmacodynamic peculiarities of the antibacterial preparations, did not determine the expected results in all cases, the lethality constituting 44% of the cases. The objective of the study consisted in the analysis of the factors, such as: the pharmacological aspects of the antibacterial preparations, the physiological and pathological peculiarities in the elderly, the associated pathologies; that are responsible for the eff ectiveness of antibiotic therapy in patients with nosocomial pneumonia.
References
1. COLŢEANU G. C., ANDREESCU, O. Pneumonia nosocomială, de la tratamentul empiric la schemele terapeutice specifice. In: Jurnal Medical Brașovean; Brașov, 2021, nr. 2, pp. 4-12. https://doi.org/10.31926/jmb.2021.2.4
2. BOTNARU V., RUSU D.,TOMA C. Protocol clinic naţional "Pneumonia nosocomială la adult" Chișinău, 2020.
3. SASU B., CEPOIDA P. Protocol clinic naţional "Pielonefrita cronică la adult" Chișinău, 2017.
4. TOMA C. Particularităţile etiologice, clinico-epidemiologice şi de mana-gement ale pneumoniilor nosocomiale de nivelul instituţiei medicale republicane, tz. de doct. în med. Chişinău, 2021. 179 p.
5. ZNAGOVAN, A. Legea, medicamentul şi sănătatea. In: Studia Universitatis Moldaviae (Seria Ştiinţe Sociale), Chișinău, 2019, nr. 11, pp. 110-118.
6. AOUN, M, et al. Drug treatment of pneumonia in the hospital. What are the choices?. In.: Drugs, 1991, vol. 42, pp. 962-73. https://doi.org/10.2165/00003495-199142060-00005
7. ASHLEY C, DUNLEAVY A. The Renal Drug Handbook. 4th ed, London, Taylor & Francis Group, 2014, pp. 1016.
8. BERMAN, S. J. et al. Meropenem monotherapy for the treatment of hospital-acquired pneumonia: results of a multicenter trial. In: Journal of chemotherapy, 2004 vol. 16,4, pp. 362-71. https://doi.org/10.1179/joc.2004.16.4.362
9. BURKE A. CUNHA. Antibiotic essentials, 14th ed: London, Jaypee Brothers Medical Publishers Pvt. Ltd., 2015, pp.803.
10. BUTRANOVA O., ZYRYANOV S.K. Elderly patients in randomized clinical trials: ethical issues. In: Medical Ethics, 2023, pp. 4-8. https://doi.org/10.24075/medet.2023.005
11. BUTRANOVA O., USHKALOVA E.A., et al. Pharmacokinetics of Anti-bacterial Agents in the Elderly: The Body of Evidence. In: Biomedicines, 2023, 11(6), pp.1633. https://doi.org/10.3390/biomedicines11061633
12. CANDEL F.J., et al. Ten Issues to Update in Nosocomial or Hospital-Acquired Pneumonia: An Expert Review. In: Journal of Clinical medicine, 2023, 12 (20), pp. 6526. https://doi.org/10.3390/jcm12206526
13. CISNEROS J.M., ROSSO-FERNÁNDEZ C.M., et al. Colistin versus meropenem in the empirical treatment of ventilator-associated pneumonia (Magic Bullet study): an investigator-driven, open-label, randomized, noninferiority controlled trial. In: Critical Care. 2019, 23 pp.383. https://doi.org/10.1186/s13054-019-2627-y
14. CORONA A., et al. Antibiotic Therapy in the Critically Ill with Acute Renal Failure and Renal Replacement Therapy: A Narrative Review. In: Journal Antibiotics. 2022, vol. 11(12), pp. 1769. https://doi.org/10.3390/antibiotics11121769
15. COMPTÉ, N., et al. White blood cell counts in a geriatric hospitalized population: A poor diagnostic marker of infection. In: Experimental Gerontology, 2018, vol.114, pp. 87-92. https://doi.org/10.1016/j.exger.2018.11.002
16. GORHAM J., TACCONE F.S., HITES M. How to Use Nebulized Antibiotics in Severe Respiratory Infections. In: Journal Antibiotics. 2023 vol. 12 (2), pp. 267. https://doi.org/10.3390/antibiotics12020267
17. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171(4), pp. 388- 416. https://doi.org/10.1164/rccm.200405-644ST
18. HEFFERNAN A.J., SIME F.B., et al. Multicenter Population Pharmacokinetic Study of Unbound Ceftriaxone in Critically Ill Patients. In: Antimicrobial Agents and Chemotherapy, 2022, vol. 66 (6), pp. 21. https://doi.org/10.1128/aac.02189-21
19. LEVISON M.E., LEVISON J.H. Pharmacokinetics and pharmacodynamics of antibacterial agents. In: Infectious Disease Clinics of North America, 2009, vol. 23 (4), pp.791-815. https://doi.org/10.1016/j.idc.2009.06.008
20. LUQUE PAZ D., et al. Efficacy and safety of antibiotics targeting Gram-negative bacteria in nosocomial pneumonia: a systematic review and Bayesian network meta-analysis. In: Annals of Intensive Care, 2024, vol. 14, pp. 66. https://doi.org/10.1186/s13613-024-01291-5
21. MIRON M., BLAJ M., RISTESCU A.I. et al. Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Literature Review. In: Micro-organisms, 2024, vol. 12 (2), pp. 213. https://doi.org/10.3390/microorganisms12010213
22. MORALES CASTRO D., et al. Pharmacokinetic Alterations Associated with Critical Illness. In: Clinical Pharmacokinetics, 2023, vol. 62 (2), pp. 209-220. https://doi.org/10.1007/s40262-023-01213-x
23. MUJAL A., SOLA J., et al. Safety and effectiveness of home intravenous antibiotic therapy for multidrug-resistant bacterial infections. In: European Journal of Clinical Microbiology & Infectious Diseases, 2015, vol. 34 (6), pp.1125-1133. https://doi.org/10.1007/s10096-015-2330-0
24. PEA F. Intracellular Pharmacokinetics of Antibacterials and Their Clinical Implications. In: Clinical Pharmacokinetics, 2018, vol. 57 (2), pp.177-189. https://doi.org/10.1007/s40262-017-0572-y
25. PONTI F, SANTORO A, et al. Aging and Imaging Assessment of Body Composition: From Fat to Facts. In: Frontiers in Endocrinology. 2020, vol. 10, pp. 861. https://doi.org/10.3389/fendo.2019.00861
26. PÓVOA P., et al. Optimizing Antimicrobial Drug Dosing in Critically Ill Patients. In: Microorganisms, 2021, vol. 9 (7), pp.1401. https://doi.org/10.3390/microorganisms9071401
27. PRINA E, RANZANI O.T., et al. Risk factors associated with potentially antibiotic-resistant pathogens in community-acquired pneumonia. In: Annals of the American Thoracic Society, 2015, vol. 12(2), pp.153- 160. https://doi.org/10.1513/AnnalsATS.201407-305OC
28. REVELES K.R., MORTENSEN E.M.,et al. Comparative-effectiveness of vancomycin and linezolid as part of guideline-recommended empiric therapy for healthcareassociated pneumonia. In: BMC Research Notes, 2015, vol.8, pp. 450. https://doi.org/10.1186/s13104-015-1396-1
29. RODRÍGUEZ-LEAL C.M., et al. Medical societies for the 5th edition of Pneumonia Day. Candent issues in pneumonia. Reflections from the Fifth Annual Meeting of Spanish Experts 2023. In: Revista Española de Quimioterapia, 2024, vol. 37 (3), pp. 221-251. https://doi.org/10.37201/req/018.2024
30. RUIZ-RAMOS J., et al. Antimicrobial Pharmacokinetics and Pharmacodynamics in Critical Care: Adjusting the Dose in Extracorporeal Circulation and to Prevent the Genesis of Multiresistant Bacteria. In: Antibiotics, 2023, vol. 12 (3), pp. 475. https://doi.org/10.3390/antibiotics12030475
31. The European Committee on Antimicrobial Susceptibility Testing. Break-point tables for interpretation of MICs and zone diameters. Version 13.0, 2023.
32. TROTMAN R.L., et al. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy. In: Clinical Infectious Diseases, 2005 vol. 41(8), pp. 1159-66. https://doi.org/10.1086/444500
33. UNERTL K.E, et al. Systemic antibiotic treatment of nosocomial pneumonia. In: Intensive Care Medicine, 1992, vol.18, pp.S 28- S34. https://doi.org/10.1007/BF01752974
34. VALLÉS J., MARTIN-LOECHES I., et al. Epidemiology, antibiotic therapy and clinical outcomes of healthcare-associated pneumonia in critically ill patients: a Spanish cohort study. In: Intensive Care Medicine, 2014, vol. 40 (4), pp. 572-581. https://doi.org/10.1007/s00134-014-3239-2
35. YEH J.C., HAZAM P.K., et al. Rational Design of Stapled Antimicrobial Peptides to Enhance Stability and In Vivo Potency against Polymicrobial Sepsis. In: Microbiology Spectrum, 2023, vol. 11(2), pp. 22. https://doi.org/10.1128/spectrum.03853-22
36. АНТОНОВИЧ Ж.В. Нозокомиальная пневмония: современные подходы к диагностике и лечению. B: Неотложная кардиология и кардио-васкулярные риски, 2019. Т. 3, № 2, c. 626-635.
37. БЕЛОЦЕРКОВСКИЙ Б.З., и др. Антибактериальная терапия нозокомиальной пневмонии в эпоху роста резистентности к карбапенемам. B: Анестезиология и реаниматология, 2018, № 5, с. 22-35.
38. ЗЫРЯНОВ С.К., БУТРАНОВА О.И. Ингаляционные антибактериальные препараты: современные возможности применения при инфекциях дыхательных путей. B: Пульмонология, 2020, c. 320-328.
39. ЗЫРЯНОВ С.К., БУТРАНОВА О.И. Современные подходы к выбору антибиотика для терапии внебольничной пневмонии у различных категорий пациентов. B: Качественная клиническая практика, 2019, № 1, c. 97-113.
40. КОРЖОВА Н.B. Особенности эпидемиологии и клиники нозокомиальной пневмонии в многопрофильном стационаре. B: Бюллетень физиологии и патологии дыхания, 2015, № 58, c. 41-46.
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