Этиология тяжелой внебольничной пневмонии у взрослых: результаты первого российского многоцентрового исследования
Этиология тяжелой внебольничной пневмонии у взрослых: результаты первого российского многоцентрового исследования
Захаренков И.А., Рачина С.А., Дехнич Н.Н. и др. Этиология тяжелой внебольничной пневмонии у взрослых: результаты первого российского многоцентрового исследования. Терапевтический архив. 2020; 92 (1): 36–42. DOI: 10.26442/ 00403660.2020.01.000491
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Аннотация
Цель – изучить структуру возбудителей тяжелой внебольничной пневмонии (ТВП) у взрослых больных в Российской Федерации (РФ). ТВП относится к заболеваниям с высокой летальностью и отличается значимым социально-экономическим бременем для общества. Адекватная эмпирическая антибактериальная терапия должна основываться на знании спектра ключевых возбудителей и их чувствительности к антимикробным препаратам.
Материалы и методы. В проспективное исследование, выполнявшееся в многопрофильных стационарах 6 городов РФ в 2014–2018 гг., включались взрослые пациенты с подтвержденным диагнозом ТВП. Для верификации этиологии культуральным методом исследовались кровь, респираторные образцы (мокрота, эндотрахеальный аспират, бронхоальвеолярный лаваж), аутопсийные образцы у умерших пациентов; использовались экспресс-тесты для выявления антигенурии (L. pneumophila cерогруппа 1 и S. pneumoniae). «Aтипичные» бактериальные патогены (M. pneumoniae, C. pneumoniae, L. pneumophila) и респираторные вирусы (вирусы гриппа А и В, парагриппа, риновирус, метапневмовирус человека и др.) выявлялись методом полимеразной цепной реакции в режиме реального времени с помощью коммерческих тестов.
Результаты. Всего в исследование включено 109 пациентов (мужчин – 60,6%, средний возраст 50,8±18,0 лет) с ТВП. Этиологически значимые возбудители ТВП обнаружены в 65,1% случаев; наиболее часто выявлялись S. pneumoniae, риновирусы, S. aureus и K. pneumoniae (43,7, 15,5, 14,1 и 11,3% пациентов c положительными результатами микробиологического исследования соответственно). Бактериемия выявлена в 14,6% случаев, S. pneumoniae являлся наиболее часто идентифицируемым патогеном. Два и более возбудителя ТВП выявлены в 36,6% случаев. Среди комбинаций превалировало сочетание бактериальных возбудителей (чаще всего S. pneumoniae с S. aureus или/и Enterobacterales) – 57,7%; ассоциации бактериальных возбудителей и вирусов выявлены у 38,5% пациентов, в 1 случае выявлена ко-инфекция двумя респираторными вирусами.
Заключение. В структуре этиологии ТВП у госпитализированных взрослых больных преобладал S. pneumoniae. Следует отметить высокую частоту выявления респираторных вирусов (преимущественно риновирус и вирусы гриппа) как в ассоциации с бактериальными возбудителями, так и в монокультуре.
Ключевые слова: тяжелая внебольничная пневмония, этиология, микробиологическая диагностика.
Materials and methods. A prospective cohort study recruited adults with confirmed diagnosis of SCAP admitted to multi-word hospitals of six Russian cities in 2014–2018. Etiology was confirmed by routine culture of blood, respiratory (sputum, endotracheal aspirate or bronchoalveolar lavage) and when appropriate, autopsy samples, urinary antigen tests (L. pneumophila serogroup 1, S. pneumoniae); real-time PCR for identification of “atypical” bacterial pathogens (M. pneumoniae, C. pneumoniae, L. pneumophila) and respiratory viruses (influenza viruses A and B, parainfluenza, human metapneumovirus, etc.) was applied.
Results. Altogether 109 patients (60.6% male; mean age 50.8±18.0 years old) with SCAP were enrolled. Etiological agent was identified in 65.1% of patients, S. pneumoniae, rhinovirus, S. aureus and K. pneumoniae were the most commonly isolated pathogens (found in 43.7, 15.5, 14.1 and 11.3% of patients with positive results of microbiological investigations, respectively). Bacteriemia was seen in 14.6% of patients and most commonly associated with S. pneumoniae. Co-infection with 2 or more causative agents was revealed in 36.6% of cases. Combination of bacterial pathogens (mainly S. pneumoniae with S. aureus or/and Enterobacterales) prevailed – 57.7% of cases; associations of bacteria and viruses were identified in 38.5% of patients, different viruses – in one case.
Conclusion. S. pneumoniae was the most common pathogen in adults with SCAP. A high rate of respiratory viruses (mainly rhinovirus and influenza viruses) identification both as mixt infection with bacteria and mono-infection should be taken into account.
Keywords: severe community-acquired pneumonia, etiology, microbiological diagnostics.
Материалы и методы. В проспективное исследование, выполнявшееся в многопрофильных стационарах 6 городов РФ в 2014–2018 гг., включались взрослые пациенты с подтвержденным диагнозом ТВП. Для верификации этиологии культуральным методом исследовались кровь, респираторные образцы (мокрота, эндотрахеальный аспират, бронхоальвеолярный лаваж), аутопсийные образцы у умерших пациентов; использовались экспресс-тесты для выявления антигенурии (L. pneumophila cерогруппа 1 и S. pneumoniae). «Aтипичные» бактериальные патогены (M. pneumoniae, C. pneumoniae, L. pneumophila) и респираторные вирусы (вирусы гриппа А и В, парагриппа, риновирус, метапневмовирус человека и др.) выявлялись методом полимеразной цепной реакции в режиме реального времени с помощью коммерческих тестов.
Результаты. Всего в исследование включено 109 пациентов (мужчин – 60,6%, средний возраст 50,8±18,0 лет) с ТВП. Этиологически значимые возбудители ТВП обнаружены в 65,1% случаев; наиболее часто выявлялись S. pneumoniae, риновирусы, S. aureus и K. pneumoniae (43,7, 15,5, 14,1 и 11,3% пациентов c положительными результатами микробиологического исследования соответственно). Бактериемия выявлена в 14,6% случаев, S. pneumoniae являлся наиболее часто идентифицируемым патогеном. Два и более возбудителя ТВП выявлены в 36,6% случаев. Среди комбинаций превалировало сочетание бактериальных возбудителей (чаще всего S. pneumoniae с S. aureus или/и Enterobacterales) – 57,7%; ассоциации бактериальных возбудителей и вирусов выявлены у 38,5% пациентов, в 1 случае выявлена ко-инфекция двумя респираторными вирусами.
Заключение. В структуре этиологии ТВП у госпитализированных взрослых больных преобладал S. pneumoniae. Следует отметить высокую частоту выявления респираторных вирусов (преимущественно риновирус и вирусы гриппа) как в ассоциации с бактериальными возбудителями, так и в монокультуре.
Ключевые слова: тяжелая внебольничная пневмония, этиология, микробиологическая диагностика.
________________________________________________
Materials and methods. A prospective cohort study recruited adults with confirmed diagnosis of SCAP admitted to multi-word hospitals of six Russian cities in 2014–2018. Etiology was confirmed by routine culture of blood, respiratory (sputum, endotracheal aspirate or bronchoalveolar lavage) and when appropriate, autopsy samples, urinary antigen tests (L. pneumophila serogroup 1, S. pneumoniae); real-time PCR for identification of “atypical” bacterial pathogens (M. pneumoniae, C. pneumoniae, L. pneumophila) and respiratory viruses (influenza viruses A and B, parainfluenza, human metapneumovirus, etc.) was applied.
Results. Altogether 109 patients (60.6% male; mean age 50.8±18.0 years old) with SCAP were enrolled. Etiological agent was identified in 65.1% of patients, S. pneumoniae, rhinovirus, S. aureus and K. pneumoniae were the most commonly isolated pathogens (found in 43.7, 15.5, 14.1 and 11.3% of patients with positive results of microbiological investigations, respectively). Bacteriemia was seen in 14.6% of patients and most commonly associated with S. pneumoniae. Co-infection with 2 or more causative agents was revealed in 36.6% of cases. Combination of bacterial pathogens (mainly S. pneumoniae with S. aureus or/and Enterobacterales) prevailed – 57.7% of cases; associations of bacteria and viruses were identified in 38.5% of patients, different viruses – in one case.
Conclusion. S. pneumoniae was the most common pathogen in adults with SCAP. A high rate of respiratory viruses (mainly rhinovirus and influenza viruses) identification both as mixt infection with bacteria and mono-infection should be taken into account.
Keywords: severe community-acquired pneumonia, etiology, microbiological diagnostics.
Список литературы
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5. Cilloniz C, Ewig S, Ferrer M, et al. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. Crit Care. 2011;15:R209. doi: 10.1186/cc10444
6. Sligl WI, Marrie TJ. Severe community acquired pneumonia. Crit Care Clin. 2013;29:563-601. doi: 10.1016/j.ccc.2013.03.009
7. Garnacho-Montero J, Barrero-García I, Gómez-Prieto MG, et al. Severe community-acquired pneumonia: current management and future therapeutic alternatives. Expert Rev Anti Infect Ther. 2018;16(9):667-77. doi: 10.1080/14787210.2018.1512403
8. Ежлова Е.Б., Демина Ю.В., Шеенков Н.В. и др. Лабораторная диагностика внебольничных пневмоний. Методические указания МУК 4.2.3115 -13. Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека. М., 2013 [Yezhlova EB, Demina YuV, Sheenkov NV, et al. Laboratory diagnosis of community-acquired pneumonia. Guidelines MUK 4.2.3115 -13. Federal Service for the Oversight of Consumer Protection and Welfare. Moscow, 2013 (In Russ.)].
9. Ruiz M, Ewig S, Marcos MA, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity and severity. Am J Respir Crit Care Med. 1999;160(2):397-405. doi: 10.1164/ajrccm.160.2.9808045
10. Jokinen C, Heiskanen L, Juvonen H, et al. Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland. Clin Infect Dis. 2001;32(8):1141-54. doi: 10.1086/319746
11. Рачина С.А., Козлов Р.С., Шаль Е.П. и др. Структура бактериальных возбудителей внебольничной пневмонии в многопрофильных стационарах г. Смоленска. Пульмонология. 2011;(1):5-18 [Rachina SA, Kozlov RS, Shal EP, et al. A spectrum of causative bacterial pathogens in community-acquired pneumonia in multidisciplinary hospitals of Smolensk. Russian Pulmonology. 2011;(1):5-18 (In Russ.)]. doi: 10.18093/0869-0189-2011-0-1-5-18
12. Torres A, Blasi F, Peetermans WE, et al. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis. 2014;33(7):1065-79. doi: 10.1007/s10096-014-2067-1
13. Рачина С.А., Иванчик Н.В., Козлов Р.С. Особенности микробиологической диагностики при внебольничной пневмонии у взрослых. Практическая пульмонология. 2016;(4):40-7 [Rachina SA, Ivanchik NV, Kozlov RS. Microbiology Diagnostics of Community-acquired Pneumonia in Adults. Practical pulmonology. 2016; (4):40-7 (In Russ.)].
14. Johansson N, Kalin M, Tiveljung-Lindell A, et al. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010;50:202-9. doi: 10.1086/648678
15. Lanspa MJ, Peyrani P, Wiemken T, et al. Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes. J Hosp Med. 2015;10:90-6. doi: 10.1002/jhm.2280
16. Hariri G, Tankovic J, Boëlle PY, et al. Are third-generation cephalosporins unavoidable for empirical therapy of community-acquired pneumonia in adult patients who require ICU admission? A retrospective study. Ann Intensive Care. 2017;7(1):35. doi: 10.1186/s13613-017-0259-4
17. Walden AP, Clarke GM, McKechnie S, et al; ESICM/ECCRN GenOSept Investigators. Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Crit Care. 2014;18(2):R58. doi: 10.1186/cc13812
18. Quah J, Jiang B, Tan PC, et al. Impact of microbial Aetiology on mortality in severe community-acquired pneumonia. BMC Infect Dis. 2018;18(1):451. doi: 10.1186/s12879-018-3366-4
19. Choi SH, Hong SB, Ko GB, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med. 2012;186:325-32. doi: 10.1164/rccm.201112-2240OC
20. Piralla A, Mariani B, Rovida F, et al. Frequency of respiratory viruses among patients admitted to 26 intensive care units in seven consecutive winter-spring seasons (2009–2016) in northern Italy. J Clin Virol. 2017;92:48-51. doi: 10.1016/j.jcv.2017.05.004
21. Bjarnason A, Westin J, Lindh M, et al. Incidence, Etiology, and Outcomes of Community-Acquired Pneumonia: A Population-Based Study. Open Forum Infect Dis. 2018;5(2):ofy010. doi: 10.1093/ofid/ofy010
22. de Roux A, Ewig S, Garcia E, et al. Mixed community-acquired pneumonia in hospitalized patients. Eur Respir J. 2006;27:795-800. doi: 10.1183/09031936.06.00058605
23. Robinson KM, Kolls JK, Alcorn JF, et al. The immunology of influenza virus-associated bacterial pneumonia. Curr Opin Immunol. 2015;34:59-67. doi: 10.1016/j.coi.2015.02.002
24. Shinya K, Gao Y, Cilloniz C, et al. Integrated clinical, pathologic, virologic, and transcriptomic analysis of H5N1 influenza virus-induced viral pneumonia in the rhesus macaque. J Virol. 2012;86(11):6055-66. doi: 10.1128/JVI.00365-12
25. Smith AM, Adler FR, Ribeiro RM, et al. Kinetics of coinfection with influenza a virus and Streptococcus pneumoniae. PLoS Pathog. 2013;9(3):e1003238. doi: 10.1371/journal. ppat.1003238
26. von Baum H, Welte T, Marre R, et al. Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ). BMC Infect Dis. 2009;9:62. doi: 10.1186/1471-2334-9-62
27. Waites KB, Xiao L, Liu Y, et al. Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev. 2017;30(3):747-809. doi:10.1128/CMR.00114-16
28. Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Клинические рекомендации по диагностике, лечению и профилактике тяжелой внебольничной пневмонии у взрослых. Пульмонология. 2014;14(4):13-48 [Chuchalin AG, Sinopal'nikov AI, Kozlov RS, et al. Russian Respiratory Society Interregional association on clinical microbiology and antimicrobial chemotherapy Clinical guidelines on diagnosis, treatment and prevention of severe community acquired pneumonia in adults. Russian Pulmonology. 2014;14(4):13-48 (In Russ.)]. doi:10.18093/0869-0189-2014-0-4-13-48
29. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27-S72. doi: 10.1086/511159
2. Jain S, Self WH, Wunderink RG, et al. Community-Acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373:415-27. doi: 10.1056/ NEJMoa1500245
3. The top 10 causes of death: 2018 update. World Health Organization. Accessed Jule 20, 2019: http://www.who.int
4. Ewig S, Woodhead M, Torres A. Towards a sensible comprehension of severe community-acquired pneumonia. Intensive Care Med. 2011;37:214-23. doi: 10.1007/s00134-010-2077-0
5. Cilloniz C, Ewig S, Ferrer M, et al. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. Crit Care. 2011;15:R209. doi: 10.1186/cc10444
6. Sligl WI, Marrie TJ. Severe community acquired pneumonia. Crit Care Clin. 2013;29:563-601. doi: 10.1016/j.ccc.2013.03.009
7. Garnacho-Montero J, Barrero-García I, Gómez-Prieto MG, et al. Severe community-acquired pneumonia: current management and future therapeutic alternatives. Expert Rev Anti Infect Ther. 2018;16(9):667-77. doi: 10.1080/14787210.2018.1512403
8. Yezhlova EB, Demina YuV, Sheenkov NV, et al. Laboratory diagnosis of community-acquired pneumonia. Guidelines MUK 4.2.3115 -13. Federal Service for the Oversight of Consumer Protection and Welfare. Moscow, 2013 (In Russ.)
9. Ruiz M, Ewig S, Marcos MA, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity and severity. Am J Respir Crit Care Med. 1999;160(2):397-405. doi: 10.1164/ajrccm.160.2.9808045
10. Jokinen C, Heiskanen L, Juvonen H, et al. Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland. Clin Infect Dis. 2001;32(8):1141-54. doi: 10.1086/319746
11. Rachina SA, Kozlov RS, Shal EP, et al. A spectrum of causative bacterial pathogens in community-acquired pneumonia in multidisciplinary hospitals of Smolensk. Russian Pulmonology. 2011;(1):5-18 (In Russ.) doi: 10.18093/0869-0189-2011-0-1-5-18
12. Torres A, Blasi F, Peetermans WE, et al. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis. 2014;33(7):1065-79. doi: 10.1007/s10096-014-2067-1
13. Rachina SA, Ivanchik NV, Kozlov RS. Microbiology Diagnostics of Community-acquired Pneumonia in Adults. Practical pulmonology. 2016; (4):40-7 (In Russ.)
14. Johansson N, Kalin M, Tiveljung-Lindell A, et al. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010;50:202-9. doi: 10.1086/648678
15. Lanspa MJ, Peyrani P, Wiemken T, et al. Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes. J Hosp Med. 2015;10:90-6. doi: 10.1002/jhm.2280
16. Hariri G, Tankovic J, Boëlle PY, et al. Are third-generation cephalosporins unavoidable for empirical therapy of community-acquired pneumonia in adult patients who require ICU admission? A retrospective study. Ann Intensive Care. 2017;7(1):35. doi: 10.1186/s13613-017-0259-4
17. Walden AP, Clarke GM, McKechnie S, et al; ESICM/ECCRN GenOSept Investigators. Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Crit Care. 2014;18(2):R58. doi: 10.1186/cc13812
18. Quah J, Jiang B, Tan PC, et al. Impact of microbial Aetiology on mortality in severe community-acquired pneumonia. BMC Infect Dis. 2018;18(1):451. doi: 10.1186/s12879-018-3366-4
19. Choi SH, Hong SB, Ko GB, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med. 2012;186:325-32. doi: 10.1164/rccm.201112-2240OC
20. Piralla A, Mariani B, Rovida F, et al. Frequency of respiratory viruses among patients admitted to 26 intensive care units in seven consecutive winter-spring seasons (2009–2016) in northern Italy. J Clin Virol. 2017;92:48-51. doi: 10.1016/j.jcv.2017.05.004
21. Bjarnason A, Westin J, Lindh M, et al. Incidence, Etiology, and Outcomes of Community-Acquired Pneumonia: A Population-Based Study. Open Forum Infect Dis. 2018;5(2):ofy010. doi: 10.1093/ofid/ofy010
22. de Roux A, Ewig S, Garcia E, et al. Mixed community-acquired pneumonia in hospitalized patients. Eur Respir J. 2006;27:795-800. doi: 10.1183/09031936.06.00058605
23. Robinson KM, Kolls JK, Alcorn JF, et al. The immunology of influenza virus-associated bacterial pneumonia. Curr Opin Immunol. 2015;34:59-67. doi: 10.1016/j.coi.2015.02.002
24. Shinya K, Gao Y, Cilloniz C, et al. Integrated clinical, pathologic, virologic, and transcriptomic analysis of H5N1 influenza virus-induced viral pneumonia in the rhesus macaque. J Virol. 2012;86(11):6055-66. doi: 10.1128/JVI.00365-12
25. Smith AM, Adler FR, Ribeiro RM, et al. Kinetics of coinfection with influenza a virus and Streptococcus pneumoniae. PLoS Pathog. 2013;9(3):e1003238. doi: 10.1371/journal. ppat.1003238
26. von Baum H, Welte T, Marre R, et al. Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ). BMC Infect Dis. 2009;9:62. doi: 10.1186/1471-2334-9-62
27. Waites KB, Xiao L, Liu Y, et al. Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev. 2017;30(3):747-809. doi:10.1128/CMR.00114-16
28. Chuchalin AG, Sinopal'nikov AI, Kozlov RS, et al. Russian Respiratory Society Interregional association on clinical microbiology and antimicrobial chemotherapy Clinical guidelines on diagnosis, treatment and prevention of severe community acquired pneumonia in adults. Russian Pulmonology. 2014;14(4):13-48 (In Russ.) doi:10.18093/0869-0189-2014-0-4-13-48
29. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27-S72. doi: 10.1086/511159
2. Jain S, Self WH, Wunderink RG, et al. Community-Acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373:415-27. doi: 10.1056/ NEJMoa1500245
3. The top 10 causes of death: 2018 update. World Health Organization. Accessed Jule 20, 2019: http://www.who.int
4. Ewig S, Woodhead M, Torres A. Towards a sensible comprehension of severe community-acquired pneumonia. Intensive Care Med. 2011;37:214-23. doi: 10.1007/s00134-010-2077-0
5. Cilloniz C, Ewig S, Ferrer M, et al. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. Crit Care. 2011;15:R209. doi: 10.1186/cc10444
6. Sligl WI, Marrie TJ. Severe community acquired pneumonia. Crit Care Clin. 2013;29:563-601. doi: 10.1016/j.ccc.2013.03.009
7. Garnacho-Montero J, Barrero-García I, Gómez-Prieto MG, et al. Severe community-acquired pneumonia: current management and future therapeutic alternatives. Expert Rev Anti Infect Ther. 2018;16(9):667-77. doi: 10.1080/14787210.2018.1512403
8. Ежлова Е.Б., Демина Ю.В., Шеенков Н.В. и др. Лабораторная диагностика внебольничных пневмоний. Методические указания МУК 4.2.3115 -13. Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека. М., 2013 [Yezhlova EB, Demina YuV, Sheenkov NV, et al. Laboratory diagnosis of community-acquired pneumonia. Guidelines MUK 4.2.3115 -13. Federal Service for the Oversight of Consumer Protection and Welfare. Moscow, 2013 (In Russ.)].
9. Ruiz M, Ewig S, Marcos MA, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity and severity. Am J Respir Crit Care Med. 1999;160(2):397-405. doi: 10.1164/ajrccm.160.2.9808045
10. Jokinen C, Heiskanen L, Juvonen H, et al. Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland. Clin Infect Dis. 2001;32(8):1141-54. doi: 10.1086/319746
11. Рачина С.А., Козлов Р.С., Шаль Е.П. и др. Структура бактериальных возбудителей внебольничной пневмонии в многопрофильных стационарах г. Смоленска. Пульмонология. 2011;(1):5-18 [Rachina SA, Kozlov RS, Shal EP, et al. A spectrum of causative bacterial pathogens in community-acquired pneumonia in multidisciplinary hospitals of Smolensk. Russian Pulmonology. 2011;(1):5-18 (In Russ.)]. doi: 10.18093/0869-0189-2011-0-1-5-18
12. Torres A, Blasi F, Peetermans WE, et al. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis. 2014;33(7):1065-79. doi: 10.1007/s10096-014-2067-1
13. Рачина С.А., Иванчик Н.В., Козлов Р.С. Особенности микробиологической диагностики при внебольничной пневмонии у взрослых. Практическая пульмонология. 2016;(4):40-7 [Rachina SA, Ivanchik NV, Kozlov RS. Microbiology Diagnostics of Community-acquired Pneumonia in Adults. Practical pulmonology. 2016; (4):40-7 (In Russ.)].
14. Johansson N, Kalin M, Tiveljung-Lindell A, et al. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010;50:202-9. doi: 10.1086/648678
15. Lanspa MJ, Peyrani P, Wiemken T, et al. Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes. J Hosp Med. 2015;10:90-6. doi: 10.1002/jhm.2280
16. Hariri G, Tankovic J, Boëlle PY, et al. Are third-generation cephalosporins unavoidable for empirical therapy of community-acquired pneumonia in adult patients who require ICU admission? A retrospective study. Ann Intensive Care. 2017;7(1):35. doi: 10.1186/s13613-017-0259-4
17. Walden AP, Clarke GM, McKechnie S, et al; ESICM/ECCRN GenOSept Investigators. Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Crit Care. 2014;18(2):R58. doi: 10.1186/cc13812
18. Quah J, Jiang B, Tan PC, et al. Impact of microbial Aetiology on mortality in severe community-acquired pneumonia. BMC Infect Dis. 2018;18(1):451. doi: 10.1186/s12879-018-3366-4
19. Choi SH, Hong SB, Ko GB, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med. 2012;186:325-32. doi: 10.1164/rccm.201112-2240OC
20. Piralla A, Mariani B, Rovida F, et al. Frequency of respiratory viruses among patients admitted to 26 intensive care units in seven consecutive winter-spring seasons (2009–2016) in northern Italy. J Clin Virol. 2017;92:48-51. doi: 10.1016/j.jcv.2017.05.004
21. Bjarnason A, Westin J, Lindh M, et al. Incidence, Etiology, and Outcomes of Community-Acquired Pneumonia: A Population-Based Study. Open Forum Infect Dis. 2018;5(2):ofy010. doi: 10.1093/ofid/ofy010
22. de Roux A, Ewig S, Garcia E, et al. Mixed community-acquired pneumonia in hospitalized patients. Eur Respir J. 2006;27:795-800. doi: 10.1183/09031936.06.00058605
23. Robinson KM, Kolls JK, Alcorn JF, et al. The immunology of influenza virus-associated bacterial pneumonia. Curr Opin Immunol. 2015;34:59-67. doi: 10.1016/j.coi.2015.02.002
24. Shinya K, Gao Y, Cilloniz C, et al. Integrated clinical, pathologic, virologic, and transcriptomic analysis of H5N1 influenza virus-induced viral pneumonia in the rhesus macaque. J Virol. 2012;86(11):6055-66. doi: 10.1128/JVI.00365-12
25. Smith AM, Adler FR, Ribeiro RM, et al. Kinetics of coinfection with influenza a virus and Streptococcus pneumoniae. PLoS Pathog. 2013;9(3):e1003238. doi: 10.1371/journal. ppat.1003238
26. von Baum H, Welte T, Marre R, et al. Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ). BMC Infect Dis. 2009;9:62. doi: 10.1186/1471-2334-9-62
27. Waites KB, Xiao L, Liu Y, et al. Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev. 2017;30(3):747-809. doi:10.1128/CMR.00114-16
28. Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Клинические рекомендации по диагностике, лечению и профилактике тяжелой внебольничной пневмонии у взрослых. Пульмонология. 2014;14(4):13-48 [Chuchalin AG, Sinopal'nikov AI, Kozlov RS, et al. Russian Respiratory Society Interregional association on clinical microbiology and antimicrobial chemotherapy Clinical guidelines on diagnosis, treatment and prevention of severe community acquired pneumonia in adults. Russian Pulmonology. 2014;14(4):13-48 (In Russ.)]. doi:10.18093/0869-0189-2014-0-4-13-48
29. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27-S72. doi: 10.1086/511159
________________________________________________
2. Jain S, Self WH, Wunderink RG, et al. Community-Acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373:415-27. doi: 10.1056/ NEJMoa1500245
3. The top 10 causes of death: 2018 update. World Health Organization. Accessed Jule 20, 2019: http://www.who.int
4. Ewig S, Woodhead M, Torres A. Towards a sensible comprehension of severe community-acquired pneumonia. Intensive Care Med. 2011;37:214-23. doi: 10.1007/s00134-010-2077-0
5. Cilloniz C, Ewig S, Ferrer M, et al. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. Crit Care. 2011;15:R209. doi: 10.1186/cc10444
6. Sligl WI, Marrie TJ. Severe community acquired pneumonia. Crit Care Clin. 2013;29:563-601. doi: 10.1016/j.ccc.2013.03.009
7. Garnacho-Montero J, Barrero-García I, Gómez-Prieto MG, et al. Severe community-acquired pneumonia: current management and future therapeutic alternatives. Expert Rev Anti Infect Ther. 2018;16(9):667-77. doi: 10.1080/14787210.2018.1512403
8. Yezhlova EB, Demina YuV, Sheenkov NV, et al. Laboratory diagnosis of community-acquired pneumonia. Guidelines MUK 4.2.3115 -13. Federal Service for the Oversight of Consumer Protection and Welfare. Moscow, 2013 (In Russ.)
9. Ruiz M, Ewig S, Marcos MA, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity and severity. Am J Respir Crit Care Med. 1999;160(2):397-405. doi: 10.1164/ajrccm.160.2.9808045
10. Jokinen C, Heiskanen L, Juvonen H, et al. Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland. Clin Infect Dis. 2001;32(8):1141-54. doi: 10.1086/319746
11. Rachina SA, Kozlov RS, Shal EP, et al. A spectrum of causative bacterial pathogens in community-acquired pneumonia in multidisciplinary hospitals of Smolensk. Russian Pulmonology. 2011;(1):5-18 (In Russ.) doi: 10.18093/0869-0189-2011-0-1-5-18
12. Torres A, Blasi F, Peetermans WE, et al. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis. 2014;33(7):1065-79. doi: 10.1007/s10096-014-2067-1
13. Rachina SA, Ivanchik NV, Kozlov RS. Microbiology Diagnostics of Community-acquired Pneumonia in Adults. Practical pulmonology. 2016; (4):40-7 (In Russ.)
14. Johansson N, Kalin M, Tiveljung-Lindell A, et al. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010;50:202-9. doi: 10.1086/648678
15. Lanspa MJ, Peyrani P, Wiemken T, et al. Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes. J Hosp Med. 2015;10:90-6. doi: 10.1002/jhm.2280
16. Hariri G, Tankovic J, Boëlle PY, et al. Are third-generation cephalosporins unavoidable for empirical therapy of community-acquired pneumonia in adult patients who require ICU admission? A retrospective study. Ann Intensive Care. 2017;7(1):35. doi: 10.1186/s13613-017-0259-4
17. Walden AP, Clarke GM, McKechnie S, et al; ESICM/ECCRN GenOSept Investigators. Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Crit Care. 2014;18(2):R58. doi: 10.1186/cc13812
18. Quah J, Jiang B, Tan PC, et al. Impact of microbial Aetiology on mortality in severe community-acquired pneumonia. BMC Infect Dis. 2018;18(1):451. doi: 10.1186/s12879-018-3366-4
19. Choi SH, Hong SB, Ko GB, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med. 2012;186:325-32. doi: 10.1164/rccm.201112-2240OC
20. Piralla A, Mariani B, Rovida F, et al. Frequency of respiratory viruses among patients admitted to 26 intensive care units in seven consecutive winter-spring seasons (2009–2016) in northern Italy. J Clin Virol. 2017;92:48-51. doi: 10.1016/j.jcv.2017.05.004
21. Bjarnason A, Westin J, Lindh M, et al. Incidence, Etiology, and Outcomes of Community-Acquired Pneumonia: A Population-Based Study. Open Forum Infect Dis. 2018;5(2):ofy010. doi: 10.1093/ofid/ofy010
22. de Roux A, Ewig S, Garcia E, et al. Mixed community-acquired pneumonia in hospitalized patients. Eur Respir J. 2006;27:795-800. doi: 10.1183/09031936.06.00058605
23. Robinson KM, Kolls JK, Alcorn JF, et al. The immunology of influenza virus-associated bacterial pneumonia. Curr Opin Immunol. 2015;34:59-67. doi: 10.1016/j.coi.2015.02.002
24. Shinya K, Gao Y, Cilloniz C, et al. Integrated clinical, pathologic, virologic, and transcriptomic analysis of H5N1 influenza virus-induced viral pneumonia in the rhesus macaque. J Virol. 2012;86(11):6055-66. doi: 10.1128/JVI.00365-12
25. Smith AM, Adler FR, Ribeiro RM, et al. Kinetics of coinfection with influenza a virus and Streptococcus pneumoniae. PLoS Pathog. 2013;9(3):e1003238. doi: 10.1371/journal. ppat.1003238
26. von Baum H, Welte T, Marre R, et al. Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ). BMC Infect Dis. 2009;9:62. doi: 10.1186/1471-2334-9-62
27. Waites KB, Xiao L, Liu Y, et al. Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev. 2017;30(3):747-809. doi:10.1128/CMR.00114-16
28. Chuchalin AG, Sinopal'nikov AI, Kozlov RS, et al. Russian Respiratory Society Interregional association on clinical microbiology and antimicrobial chemotherapy Clinical guidelines on diagnosis, treatment and prevention of severe community acquired pneumonia in adults. Russian Pulmonology. 2014;14(4):13-48 (In Russ.) doi:10.18093/0869-0189-2014-0-4-13-48
29. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27-S72. doi: 10.1086/511159
Авторы
И.А. Захаренков1,2, С.А. Рачина3, Н.Н. Дехнич4, Р.С. Козлов2,4, А.И. Синопальников5, Н.В. Иванчик4, С.Б. Яцышина6, М.А. Елькина6, М.В. Архипенко7, С.А. Гордеева8, М.С. Лебедева9, У.С. Портнягина10
1 ГАУЗ «Брянская городская больница №1», Брянск, Россия;
2 Межрегиональная ассоциация по клинической микробиологии и антимикробной химиотерапии, Смоленск, Россия;
3 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
4 ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России, Смоленск, Россия;
5 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава Росcии, Москва, Россия;
6 ФБУН «Центральный научно-исследовательский институт эпидемиологии» Роспотребнадзора, Москва, Россия;
7 ГБУЗ «Научно-исследовательский институт – Краевая клиническая больница №1 им. проф. С.В. Очаповского» Минздрава Краснодарского края, Краснодар, Россия;
8 ГОБУЗ «Мурманская областная клиническая больница им. П.А. Баяндина», Мурманск, Россия;
9 «Санкт-Петербургский клинический научно-практический центр специализированных видов медицинской помощи (онкологический)», Санкт-Петербург, поселок Песочный, Россия;
10 ФГАОУ ВО «Северо-Восточный федеральный университет им. М.К. Аммосова», Якутск, Россия
1 Bryansk city hospital №1, Bryansk, Russia;
2 The Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, Smolensk, Russia;
3 RUDN University, Moscow, Russia;
4 Smolensk State Medical University, Smolensk, Russia;
5 Russian Medical Academy of Postgraduate Education, Moscow, Russia;
6 Central Research Institute of Epidemiology, Moscow, Russia;
7 Regional Clinical Hospital №1, Krasnodar, Russia;
8 P.A. Bayandin Murmansk State Regional Clinical Hospital, Murmansk, Russia;
9 State Budgetary Healthcare Institution «Saint-Petersburg clinical scientific and practical center for specialised types of medical care (oncological)», Saint-Petersburg, Russia;
10 M.K. Ammosov Federal North-Eastern University, Yakutsk, Russia
1 ГАУЗ «Брянская городская больница №1», Брянск, Россия;
2 Межрегиональная ассоциация по клинической микробиологии и антимикробной химиотерапии, Смоленск, Россия;
3 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
4 ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России, Смоленск, Россия;
5 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава Росcии, Москва, Россия;
6 ФБУН «Центральный научно-исследовательский институт эпидемиологии» Роспотребнадзора, Москва, Россия;
7 ГБУЗ «Научно-исследовательский институт – Краевая клиническая больница №1 им. проф. С.В. Очаповского» Минздрава Краснодарского края, Краснодар, Россия;
8 ГОБУЗ «Мурманская областная клиническая больница им. П.А. Баяндина», Мурманск, Россия;
9 «Санкт-Петербургский клинический научно-практический центр специализированных видов медицинской помощи (онкологический)», Санкт-Петербург, поселок Песочный, Россия;
10 ФГАОУ ВО «Северо-Восточный федеральный университет им. М.К. Аммосова», Якутск, Россия
________________________________________________
1 Bryansk city hospital №1, Bryansk, Russia;
2 The Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, Smolensk, Russia;
3 RUDN University, Moscow, Russia;
4 Smolensk State Medical University, Smolensk, Russia;
5 Russian Medical Academy of Postgraduate Education, Moscow, Russia;
6 Central Research Institute of Epidemiology, Moscow, Russia;
7 Regional Clinical Hospital №1, Krasnodar, Russia;
8 P.A. Bayandin Murmansk State Regional Clinical Hospital, Murmansk, Russia;
9 State Budgetary Healthcare Institution «Saint-Petersburg clinical scientific and practical center for specialised types of medical care (oncological)», Saint-Petersburg, Russia;
10 M.K. Ammosov Federal North-Eastern University, Yakutsk, Russia
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