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Some etiological, clinico-evolutive aspects and antibacterial treatment of community-acquired pneumonia


Author: Dumitraş Tatiana
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2009
Scientific adviser: Sergiu Matcovschi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 22 October, 2008
Approved by NCAA on the 22 January, 2009

Abstract

Adobe PDF document0.40 Mb / in romanian

Keywords

community-acquired pneumonia, causative agent, resistance, susceptibility, penicillin, antibacterial treatment, clinical, radiological, bacteriological efficacy, ceftriaxone, azithromycin.

Summary

The study included 250 patients (mean age 41,9±0,8 years) hospitalized with community-acquired pneumonia, of them 84 had severe pneumonia and 166 had nonsevere pneumonia. Etiological diagnosis was obtained in 51,5% by application of bacteriological examination and ELISA tests. S.pneumoniae was the main causative agent revealed in 23,3%, followed by M.pneumoniae (19,5%), C.pneumoniae (12,6%), S.pyogenes (10,4%), L.pneumophila (8,8%), S.aureus (5,9%), S.viridans (3,5%), M.catarrhalis (1,5%), H.influenzae (1%), K.pneumoniae (1%), P.aeruginosa (1%). A high level of in vitro resistance to gentamycin, tetracyclines, penicillin, ampicillin, cefazolin determined by disk diffusion method was assessed among the isolated microorganisms. A high resistence level to penicillin of S.pneumoniae (42,6%) and S.pyogenes (52,4%) was found. A more prominent systemic inflammatory response, especially the elevation of C-reactive protein, and alveolar infiltration on chest X-ray were more frequently observed in pneumonias due to S.pneumoniae and S.pyogenes. Clinical onset with dry cough, myalgias and arthralgias, interstitial pulmonary infiltration were more characteristic for community-acquired pneumonias caused by atypical agents (M.pneumoniae, C.pneumoniae). The course of pneumococcal pneumonia had some peculiarities according to susceptibility to penicillin. An acute typical onset with fever, cough, pleural pain and more evident systemic inflammatory response were revealed in case of penicillin-sensitive S.pneumoniae, while a delayed resolution of clinical symptoms and the presense of suppurative complications were more frequently assessed in case of penicillin-resistant S.pneumoniae. By inoculating 60 white mice with cultures of S.pyogenes, we revealed a higher degree of pulmonary lesions according to histopathological score in animals infected with penicillin-sensitive S.pyogenes. Both ceftiaxone and azithromycin demonstrated efficacy in the treatment of 24 white mice infected with penicillin-resistant S.pyogenes. Pneumonia had fatal outcome in 10,4% which was influenced by decreased body mass index, alcoholism, chronic liver disease, chronic renal failure, extended pulmonary infiltrate, arterial hypotension, lack of febrile reaction and consciousness disturbances. Basing on these factors a method of prognosis of community-acquired pneumonia course in patients of able-bodied age was proposed. The treatment of nonsevere community-acquired pneumonias with ceftriaxone in comparison with sequential (intravenous/ oral) azithromycin resulted in clinical efficacy of ceftriaxone in 87,8%, appropriate radiological resolution in 94,4% and bacteriological efficacy in 80%, while azithromycin – in 88,5%, 91,3% and 77,8%, respectively.