Retrospective Analysis of the Initial Empirical Antibiotic Therapy Effectiveness for Community-Acquired Pneumonia in Young Individuals in Moscow Multidisciplinary Hospital

Abstract

Despite the fact that the incidence of community-acquired pneumonia (CAP) among young people is significantly lower than among older patients, the frequency of hospitalizations for severe CAP among people under 45 years of age remains high. The effectiveness and duration of treatment directly depend on the rationally selected initial empirical antibacterial therapy (ABT).The aim of the study is to analyze the factors influencing the effectiveness of initial empiric antibacterial therapy for CAP in young people in multidisciplinary medical institutions.Materials and methods. The study was designed as a retrospective observational study; it analyzes 105 medical records of young patients with CAP admitted to one of the multidisciplinary hospitals in Moscow from 2017 to 2019.Results. The empiric ceftriaxone + azithromycin ABT regimen (70% of all prescriptions) was ineffective in 13.7% of cases; monotherapy with ceftriaxone (13% of all prescriptions) was ineffective in 57% cases. Severe CAP, acute respiratory failure, systemic inflammatory response syndrome, and exudative pleurisy were diagnosed with significantly higher frequency in the group of patients with ineffective initial empirical ABT. There was no predominance of any comorbid pathology and Charlson Comorbidity Index in groups where the initial ABT was changed and in groups without a change in initial ABT. The microbiological spectrum of CAP pathogens did not significantly differ in young patients between groups with a changed initial empirical ABT and a group without changing initial ABT.Conclusion. The reasons for the ineffectiveness of the initial empirical ABT could be such factors as: underestimation of the risk of the presence of multidrug-resistant pathogens; underestimation of the risk of viral genesis of CAP; underestimation of the severity of CAP, as well as the severity of CAP complications.