International Medical Journal, Vol. 24., Iss. 2, 2018, P. 5−11.
INDIVIDUALIZATION OF ANTIBIOTIC THERAPY FOR PNEUMONIA IN PATIENTS WITH HEMOBLASTOSIS FROM THE PERSPECTIVE OF ANTIBIOTIC RESISTANCE
Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine, Dnipro
Dnipropetrovsk Multifield Clinical Hospital № 4, Dnipro, Ukraine
Pulmonary complications often accompany diseases of the blood system and can be both manifestations of the disease itself and chemotherapy, which produces an aggressive effect on the immunity system of the patients. Pneumonia is one of the manifestations of infection complications, which pose a threat to the life of a patient with hemoblastosis. The issues of individualization of antibacterial therapy of pneumonia in patients with hemoblastosis are urgent in clinical practice. This problem can be solved by determining the spectrum of the leading pathogens of the disease and studying their sensitivity to the leading antibacterial drugs. The study performed with this purpose involved the patients with various forms of hemoblastosis and pneumonia. The material for determining the probable pathogens was bronchoalveolar lavage fluid. The microbiological study was carried out by studying native smears with the definition of the main morphological types and also in stages on dense differential−nutrient media. Sensitivity of the isolates to antibacterial drugs was determined by a disco−diffuse method. According to the results of clinical and bacterial efficacy of pneumonia treatment regimens in patients with hemoblastosis, it was determined that monotherapy with cefepime and meropenem was effective. In order to individualize antibiotic therapy of pneumonia, these regimens should be used in patients with hemoblastosis, in which pneumonia developed outside a hospital and without the signs of severe neutropenia. The clinical efficacy of antibiotic therapy of pneumonia with amikacin + meropenem and amikacin + cefepimum regimens was 83.33 % and 86.11 %, respectively. Such schemes should be recommended for individual choice of rational therapy in patients with hemoblastosis, if pneumonia occurred in a hospital and against a background of severe neutropenia.
Key words: antibacterial therapy, pneumonia, hemoblastosis.