[Differential diagnosis of cryptogenic organizing pneumonia in a patient with secondary immunodeficiency].

This differential diagnostic study included patients with the clinical picture of lower airwave infection and bilateral lung density. The difficulty of nosological verification of the diagnosis was due to the presence of neutropenia in a patient with liver cirrhosis and hypersplenism. Results of his clinical and X-ray examination were indicative of severe bacterial pneumonia. The absence of positive clinical effect of adequate antibiotic and antifungal therapy suggested the necessity to exclude not only common alternatives to pulmonary infiltrative changes (TB, lung cancer) but also interstitial diseases. Transthoracic lung biopsy permitted to identify one of the 7 morphological types of idiopathic interstitial pneumonia, cryptogenic organizing pneumonia, and perform its targeted corticosteroid therapy with a positive clinical result.

[Analysis of clinical features and outcome of nosocomial pneumonia caused by Pseudomonas aeruginosa].

This prospective study was focused on the initiation, development and outcome of nosocomial pneumonia (NP) caused by Pseudomonas aeruginosa in 51 patients receiving intensive therapy. The most characteristic features of this NP proved to be severe clinical course and poor prognosis (38% lethality). More than half of the cases developed bilateral lung disease with the predominant affection of the upper lobe in the left lung. Other frequent conditions were tissue destruction and oedema. The need of immediate hospitalization at the intensive therapy ward, septic shock, and infectious disease were predictors of fatal outcome of NP.

[Analysis of the clinical features and outcome of ventilator-associated Pseudomonas aeruginosa-related pneumonia in an intensive care unit].

The occurrence, the course, and outcome of ventilator-associated pneumonia (VAP) related to Pseudomonas aeruginosa were prospectively followed up in 51 patients treated at an intensive care unit. The characteristic feature of P. aeruginosa-induced VAP was its severe course and poor prognosis (mortality was 38%). More than half of cases were found to have bilateral lung injury with the upper left lung being involved. Lung tissue destruction and edema were rather frequent complications. The predictors of death in VAP caused by P. aeruginosa are admission to an intensive care unit, septic shock, and infection.

[Current features of antibacterial therapy of nosocomial pneumonia].

AIM: To show the role of de-escalation antibacterial therapy (ABT) in the course and outcome of nosocomial pneumonia (NP). MATERIAL AND METHODS: A prospective cohort study included 398 NP patients whose clinicomicrobiological parameters and ABT schemes were analysed. In addition, bacteriological study of secretion samples from the lower airways was made. The samples were obtained at endotracheal aspiration (ETA) and bronchoalveolar lavage (BAL). RESULTS: NP was most frequently caused by methicillin-resistant strains of S.aureus (MRSA) - 14.8%, Pseudomonas aeruginosa - 14.3%, other strain of staphylococcus - 8.8%. Initial ABT employed cefepim (30.4%) or combination of cephalosporines of the third generation with aminoglycosides (27.9%). Most of the patients (61.6%) had no escalation/de-escalation of ABT throughout the treatment. De-escalation therapy achieved lethality reduction from 23.7 to 17.0% and 42.5% vs standard and escalation ABT, respectively (p = 0.001). CONCLUSION: Schemes and regimes of ABT vary depending on population of patients with NP. De-escalation ABT of NP patients reduces lethality.