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2011, vol. 17, br. 1-2, str. 36-42
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Radiološki praćen tok vanbolničkih pneumonija i najčešće primenjeni antibiotici
Radiological monitoring of the course of community acquired pneumonias and the most frequently used antibiotics
Sažetak
Uvod. Incidencija obolevanja od pneumonije u svetu iznosi oko 1% do 1,5%, a povećava se sa starošću i postojanjem pridruženih oboljenja na 2,5% do 4,5%. Prema podacima Američkog torakalnog društva pneumonije su šesti vodeći uzrok smrti u svetu i prvi uzrok smrtnosti od infektivnih bolesti. Dijagnoza pneumonije se postavlja na osnovu kliničke slike, fizikalnog, radiološkog i mikrobiološkog nalaza. Najprihvaćenija podela pneumonija je po mestu gde je nastala: vanbolnički stečena pneumonija, bolnička pneumonija, pneumonija u jedinici intenzivne nege. Za procenu težine pneumonije i određivanja mesta gde će se lečiti, postoje različiti bodovni (ssoring) sistemi. Terapija vanbolničkih pneumonija je u većini slučajeva empirijska. Cilj rada. Utvrditi vremenski period radiološke regresije vanbolnički stečenih pneumonija i najčešće primenjenu antibiotsku terapiju. Metod. Istraživanje je sprovedeno u Domu zdravlja u Rumi, Služba pneumoftiziologije, a obuhvatilo je 137 pacijenata oba pola obolelih od vanbolnički stečene pneumonije od januara 2007. do decembra 2009. godine. Rezultati. Posle mesec dana, dobru radiološku regresiju imalo je 77,2% a lošu 22,8% pacijenata. Radi definitivne dijagnoze, kod 13 (10,6%) pacijenata je urađena kompjuterizovana tomografija (CT) grudnog koša, a kod 6 (4,9%) CT grudnog koša i bronhoskopija, kod 5 je uzet sputum za pregled na bacil tuberkuloze, od kojih su 2 (1,6%) bila pozitivna. Kod 3 (2,4%) pacijenta otkriven je karcinom bronha, a kod 2 (1,6%) metastaze na plućima. Beta-laktamske antibiotike je koristilo 84,8%, makrolide 38,2%, hinolone 21,9%, tetracikline 5,7%, aminoglikozide 2,1%. Većina (53,6%) je koristila samo jedan antibiotik, dva 33,4%, tri 10,6%, a četiri antibiotika 2,4%. Zaključak. Empirijska terapija se sprovodi odmah po otkrivanju bolesti, nakon osnovne rutinske dijagnostike, bez poznatog izolovanog uzročnika. Izbor antibiotika zavisi od očekivanog uzročnika na osnovu saznanja o najčešćem prouzrokovaču, a na koje izabrani lek deluje. Posle mesec dana, većina pacijenata u našoj studiji imala je potpunu regresiju pneumonije.
Abstract
Introduction. The incidence of pneumonia in the world is about 1% - 1.5%, and increases with age and the presence of comorbidity from 2.5% to 4.5%. %. According to data of American Thoracic Society pneumonia is the sixth leading cause of death world-wide, and first cause of death from infections. The diagnosis of pneumonia is made on the basis of clinical, physical, radiological and microbiological findings. The most popular classification of pneumonia is according to place where the patient acquired disease: community acquired pneumonia, hospital pneumonia, pneumonia in intensive care unit. For severity of pneumonia and decision about treatment there are different scoring systems. The therapy of community acquired pneumonia is empirical in most cases. Objective. Determine the time of radiological regression of community acquired pneumonia and antibiotic therapy commonly used. Method. The study was conducted in the Health Center of Ruma and included 137 patients with community acquired pneumonia in the period from Januar 2007 - to December 2009. Results. After one month radiological regression was good in 77.2% and poor in 22.8%. In order to obtain definitive diagnosis in 13 (10.6%) patients underwent CT of the chest, and 6 (4.9%) CT of the chest and bronchoscopy, and in 5 sputum examination for Mycobacterium tuberculosis (positive in 2 cases). Lung cancer was detected in 3 patients (2.4%); lung tuberculosis in 2 (1.6%) and lung metastases in 2 (1.6%) . Therapy of pneumonia was the empirical. Beta-lactam antibiotics were used in 84.8% cases, macrolides in 38.2%, quinolones in 21.9%, tetracycline in 5.7%, and aminoglycosides in 2.1%. The majority of our patients, 53.6% used only one antibiotic, 33.4% used two, 10.6% three, and 2.4% used four antibiotics. Conclusion. Empirical therapy is carried out immediately after the initial diagnosis, after routine diagnostic procedures and without isolation of pathogens. The choice of antibiotic depends on the expected cause on the basis of the most frequent causes. Most patients in our study had a complete regression of pneumonia after one month.
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Reference
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*** (2001) American Thoracic Society. Guidelines for the management of adults with communityacquired- pneumonia. Diagnosis, assessment of severity, antimicrobial therapy and prevention. Am J Respir Crit Care Med, 163(7):1730-54
|
|
 
|
Arnold, F.W., Summersgill, J.T., Lajoie, A.S., Peyrani, P., Marrie, T.J., Rossi, P., Blasi, F., Fernandez, P., File, T.M., Rello, J., Menendez, R., Marzoratti, L., Luna, C.M., Ramirez, J.A. (2007) A Worldwide Perspective of Atypical Pathogens in Community-acquired Pneumonia. American Journal of Respiratory and Critical Care Medicine, 175(10): 1086-1093
|
|
2 
|
British Thoracic Society Standards of Care Committee (2001) BTS Guidelines for the management of community acquired pneumonia in adults. Thorax, 56 Suppl 4: IV1-64
|
|
|
Bruns, A.H.W., Oosterheert, J.J., el Moussaoui, R., Opmeer, B.C., Hoepelman, A.I.M., Prins, J.M. (2010) Pneumonia recovery: discrepancies in perspectives of the radiologist, physician and patient. Journal of general internal medicine, 25(3): 203-6
|
|
|
Chaubey, V.P., Pitout, J.D., Dalton, B., Ross, T., Church, D.L., Gregson, D.B., Laupland, K.B. (2010) Clinical outcome of empiric antimicrobial therapy of bacteremia due to extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae. BMC research notes, 3: 116
|
|
3
|
Fein, A., Grossman, R., Ost, D., Farber, B., Cassiere, H. (1999) Diagnosis and management of pneumonia and other respiratory infections. Medical Publishing Company
|
|
|
Ponomarev, D. (2004) Bronhoskopija u dijagnostici bakterijskih pneumonija. Pneumon, br. 41, str. 46-52
|
|
|
Považan, Đ., Đurić, M., Kosjerina-Oštrić, V., Škrbić, D., Jović, J. (2007) Karakteristike vanbolničkih stečenih pneumonija u petnaestogodišnjem materijalu Instituta za plućne bolesti Vojvodine u Sremskoj Kamenici. Pneumon, 44:78
|
|
|
Považan, Đ., Nenić, S. (2006) Savremeni pristup bakterijskim pneumonijama. Novi Sad: Institut za plućne bolesti Sremska Kamenica
|
|
|
Sánchez, H., Albala, C., Dangour, A.D., Uauy, R. (2009) Compliance with guidelines for the management of community acquired pneumonia at primary health care centers. Revista médica de Chile, 137(12): 1575-82
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