Title (croatian) Izvanbolničke pneumonije
Title (english) Community-Acquired Pneumonias
Author Ljiljana Bulat-Kardum
Author's institution University of Rijeka Faculty of Medicine (Department of Internal Medicine)
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Internal Medicine
Abstract (croatian) Izvanbolnička je pneumonija česta, potencijalno teška bolest jer je uzrok znatnog morbiditeta i mortaliteta u odraslih. Godišnja incidencija pneumonija u općoj populaciji iznosi između 5 i 11 na 1000 osoba. Najčešći uzročnici prema publiciranim epidemiološkim studijama jesu Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Haemophilus influenzae, enterokoki i Legionella pneumophila. Za dijagnozu pneumonije potreban je novonastali infiltrat na rendgenskoj snimci prsnih organa uz tipičnu kliničku sliku. Mikrobiološka se evaluacija za ambulantno liječene bolesnike ne preporučuje. Empirijsko antibiotsko liječenje u tom slučaju gotovo je uvijek uspješno. U hospitaliziranih bolesnika, posebno kod teške pneumonije, mikrobiološka identifikacija uzročnika može pozitivno utjecati na terapijski pristup i ishod liječenja, stoga je indicirano učiniti hemokulturu, urinarni test na antigene legionele i pneumokoka te kulturu sputuma. Preporučuje se uzimanje dviju hemokultura, osobito u pacijenata sa specifičnim indikacijama kao što je liječenje u jedinici intenzivnog liječenja. Hemokulture uzete prije započetog antibiotskog liječenja pozitivne su u 7 do 16% slučajeva. Određivanje urinarnih antigena preporučuje se samo kod teške pneumonije. Unatoč mikrobiološkim testovima većina hospitaliziranih pacijenata ostaje bez etiološke dijagnoze i tretiraju se empirijski. Dva biomarkera, prokalcitonin (PCT) i C-reaktivni protein (CRP) mogu pomoći u razlučivanju bakterijskih od virusnih infekcija i u odluci o uvođenju ili obustavljanju antibiotika, a trajno visoki PCT govori u prilog lošoj prognozi. Nakon potvrde dijagnoze pneumonije potrebno je procijeniti težinu bolesti te donijeti odluku o potrebi za hospitalizacijom ili ambulantnim liječenjem. U tu se svrhu rabi više bodovnih skorova od kojih najčešće Pneumonia Severity Index (PSI) i CURB-65.
Abstract (english) Community-acquired pneumonia (CAP) is a common and potentially serious disease as it is a cause of significant morbidity and mortality in adults. The annual incidence of pneumonia in the general population in adults is 5 to 11 cases per 1000 people. According to the published epidemiological studies the most common causes of CAP in Europe, Latin America and the US are Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Haemophilus influenzae, Enterococci and Legionella pneumophila. A new infiltrate on chest X-ray with typical clinical symptoms and signs is required for the diagnosis of pneumonia. Microbiological evaluation is not recommended for outpatient treatment. Empirical antibiotic therapy almost always reveals successful clinical outcomes. In hospitalized patients, especially with severe pneumonia, microbiological identification of bacteria can positively affect the therapeutic approach and the outcome of treatment. Therefore, blood cultures, urinary antigen tests for Legionella and pneumococus and sputum culture are indicated. It is recommended to take two blood cultures, especially in patients with specific indications, such as the Intensive Care Unit treatment. Blood cultures taken before starting the antibiotic treatment are positive in 7% to 16% of cases. Legionella and S. pneumoniae urinary antigen tests are recommended only in severe pneumonias. Despite microbiological tests, most hospitalized patients with CAP are without etiological diagnosis and are treated empirically. Two biomarkers, procalcitonin (PCT) and C-reactive protein (CRP) can help distinguish bacterial from viral infections. They can support a clinical decision on the initiation or discontinuation of antibiotic therapy. Persistently high PCT values suggest a poor prognosis. After confirming the diagnosis of pneumonia, it’s necessary to assess the severity of the disease and make a decision about either hospitalization or outpatient treatment. For this purpose multiple scoring systems, such as Pneumonia Severity Index (PSI) and CURB-65, are used in everyday practice.
Keywords (croatian)
izvanbolničke pneumonije
radiološka snimka, hemokultura
test na urinarni antigen
kultura sputuma
biomarkeri
Keywords (english)
community-acquired pneumonia
chest X-ray
blood culture
urinary antigen test
sputum culture
biomarkers
Language croatian
Language english
Publication type Professional paper - Review paper
Publication status Published
Peer review Peer review
Publication version Published version
Journal title Medicus
Numbering vol. 25, no. 1 Pneumonije, pp. 31-38
p-ISSN 1330-013X
e-ISSN 1848-8315
URN:NBN urn:nbn:hr:184:791232
Publication 2016-07-13
Document URL http://hrcak.srce.hr/161763
Type of resource Text
Access conditions Open access
Terms of use
Created on 2017-10-18 21:05:04