Severe community-acquired pneumonia

Abstract

Key points• Severe community-acquired pneumonia (CAP) is associated with a high mortality rate and significant morbidity.• Of patients presenting to hospital with CAP, up to 10% will require critical care admission.• Streptococcus pneumoniae continues as the most common infective pathogen.

Do you really want to improve the results of treatment for acute pneumonia?

“…The possibility of practical implementation of such a study appears only in a limited group of patients with purulent pleural complications that develop at a certain stage of the process and previous treatment. However, even the results of this relatively small group of patients show that in 30 and more % of cases micro lora was not detected [4,9], and there is no reasoned explanation for this fact. As a result, several hundred million AР cases are diagnosed each year in the world, but their etiology remains an open question, and the choice of antimicrobials has been and is being conducted empirically [4,8,10].…”

“…In this regard, it is especially advisable to pay attention to acute in lammation in the lungs, which is a consequence of a viral infection. According to the statistics of this disease, at least a third of patients in the world have the viral nature of AР [3,4]. These indicators cannot be ignored, as the continuation of the therapeutic principle of "antibiotics alone" in the AP reveals the following fact.…”

“…The etiology of AР in most patients undergoing outpatient treatment remains unknown. But, even among hospitalized patients, the duty of such studies refers to cases of severe forms of the disease, and positive results(including cultures of blood) are found in less than half of the cases [4,8]. However, even the interpretation of the positive results of the examination does not explain such a paradox as the presence of less virulent micro lora in a number of AP observations compared with bacteriological examination of the upper respiratory tract in healthy people, when the simple presence of aggressive strains without any signs of the disease is revealed.…”

“…However, in the most severe situations with the rapid and aggressive development of the in lammatory process, another aspect of the problem is revealed, which currently continues to be explained by the extremely high virulence of the pathogen. For example, among patients hospitalized with severe AP, mortality reaches 13-28%.Among the total number of hospitalizations with AP, septic shock is diagnosed in 30% of cases, and mortality in this group increases to 50% [4,[11][12][13]. The statistics of these results seem, at irst glance, quite understandable and logical: the more severe and aggressive the disease develops, the more dif icult it is to eliminate the catastrophic violations that have arisen.…”

“…Understanding the pathophysiology of current disorders involves eliminating the re lex effect of the source of in lammation in the lungs on pulmonary blood low [15][16][17][18]. Instead, shock in AР is compared with its manifestations of another origin, and such patients begin to receive standard therapy in the form of intravenous injections with the addition of hormones and vasopressors [4,8,9,11,13,[19][20][21][22].…”