Современные руководства по ведению внебольничной пневмонии у взрослых: путь к единому стандарту | КМАХ

Современные руководства по ведению внебольничной пневмонии у взрослых: путь к единому стандарту

Клиническая Микробиология и Антимикробная Химиотерапия. 2008; 10(4):305-321

​ Гучев И.А., Синопальников А.И.
внебольничная пневмония антибактериальная терапия ведение больных руководства
Раздел
Болезни и возбудители
Тип
Журнальная статья
Публикация
Клиническая Микробиология и Антимикробная Химиотерапия. 2008; 10(4):305-321

Аннотация

Внебольничная пневмония (ВП) занимает 4–8-е место в ряду ведущих причин смерти в мире и обусловливает наибольшее число летальных исходов от инфекционных заболеваний в США. В настоящей статье представлен анализ нововведений и различий последних рекомендаций Американского общества инфекционных болезней (АОИБ) и Американского торакального общества (АТО) по ведению больных ВП, в основе которых лежит оценка тяжести течения заболевания. В соответствии с рекомендациями АОИБ в зависимости от выбора места лечения — на дому, в отделении общего профиля, в отделении интенсивной терапии (ОИТ) — различается и тактика антибактериальной терапии. Согласно рекомендациям АТО больных ВП предложено разделять на четыре группы с учётом наличия сопутствующих сердечно-сосудистых и бронхолегочных заболеваний, других факторов риска, встречи с лекарственно­устойчивыми возбудителями (антибиотикорезистентные штаммы Streptococcus pneumoniae, энтеробактерий и Pseudomonas aeruginosa), а также места лечения (на дому, в отделении общего профиля или ОИТ). И в рекомендациях АОИБ, и в рекомендациях АТО в качестве инструмента для определения места лечения выбрана шкала PORT. В то же время, в согласительных рекомендациях АОИБ и АТО с этой целью предлагается более доступная шкала CURB/CRB-65, к помощи которой следует повторно обращаться в первые несколько часов наблюдения за пациентом.

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