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.