The Practice of Antibiotic Therapy of Severe Community-Acquired Pneumonia in Adults in Russian Multidisciplinary Hospitals

Abstract

Community-acquired pneumonia (CAP) is a common cause of hospitalization and mortality worldwide. A timely start and an adequate choice of the initial antibiotic therapy (ABT) regimen are the key strategy for optimizing the prognosis in severe CAP.The aim was to study the practice of using systemic antimicrobial drugs (AMDs) in adults with severe CAP in multidisciplinary hospitals of the Russian Federation, as well as to assess compliance of initial ABT with current clinical guidelines.Methods. A prospective cohort study included adult patients with severe CAP hospitalized in multidisciplinary hospitals in 6 Russian cities during the period of 2014–2018. The adequacy criteria of the initial ABT for severe CAP were: the prescription of combination ABT, the compliance of the selected initial ABT regimen with Russian clinical guidelines, and the intravenous route of AMDs administration during the initial therapy. In addition, the frequency of using switch therapy and antimicrobial de-escalation was assessed.Results. A total of 109 patients (60.6% men; mean age 50.8±18.0 years) were included in the study. Hospital mortality was 22.9%. In all cases, AMDs were prescribed within 24 hours after admission, antiviral drugs were used in 2.8% of patients. Levofloxacin, ceftriaxone, azithromycin, amoxicillin/clavulanate were the most commonly used AMDs (prescribed in 14.4%, 12.5%, 11.9% and 10.7% of cases, respectively). Initial combination ABT was prescribed in 50.5% of patients; in 80.2% of the cases, the medications were administered intravenously. The duration of treatment was 13.9±11.2 days. Initial ABT regimens complied with Russian Clinical Guidelines in 37.6% of cases. Switch therapy and antimicrobial de-escalation was used in 11.9% and 3.6% of cases, respectively.Conclusion. Low adherence to Russian Clinical Recommendations regarding the regimens of initial ABT, as well as rare use of switch therapy and antimicrobial de-escalation were revealed.