This differential diagnostic study included patients with the clinical picture of lower airwave infection and bilateral lung density. The difficulty of nosological verification of the diagnosis was due to the presence of neutropenia in a patient with liver cirrhosis and hypersplenism. Results of his clinical and X-ray examination were indicative of severe bacterial pneumonia. The absence of positive clinical effect of adequate antibiotic and antifungal therapy suggested the necessity to exclude not only common alternatives to pulmonary infiltrative changes (TB, lung cancer) but also interstitial diseases. Transthoracic lung biopsy permitted to identify one of the 7 morphological types of idiopathic interstitial pneumonia, cryptogenic organizing pneumonia, and perform its targeted corticosteroid therapy with a positive clinical result.

This differential diagnostic study included patients with the clinical picture of lower airwave infection and bilateral lung density. The difficulty of nosological verification of the diagnosis was due to the presence of neutropenia in a patient with liver cirrhosis and hypersplenism. Results of his clinical and X-ray examination were indicative of severe bacterial pneumonia. The absence of positive clinical effect of adequate antibiotic and antifungal therapy suggested the necessity to exclude not only common alternatives to pulmonary infiltrative changes (TB, lung cancer) but also interstitial diseases. Transthoracic lung biopsy permitted to identify one of the 7 morphological types of idiopathic interstitial pneumonia, cryptogenic organizing pneumonia, and perform its targeted corticosteroid therapy with a positive clinical result.

TNF-α), интерлейкина-1 бета (IL-1β) и рецепторного антагониста интерлейкина 1 (IL1-RА).We determined the importance of genetic polymorphism in inflammation regulatory molecular CD14 (-260) C→T. It was revealed that genotype T/T associates with the severity of nosocomial pneumonia and risk of airways gram-negative microflora infection. It was proved that allele T is a marker of high risk of unfavorable outcome in the patients with nosocomial pneumonia. Hypercytokinemia of tumor necrosis factor-alfa (TNFα), interlukine-1 beta (IL-1β) and interlukine 1receptor antagonists (IL1-RA) is one of the mechanism polymorphic gene CD14 participates in immunopathogenesis of nosocomial pneumonia.

During inspection samples of DNA of 75 patients with nosocomial pneumonia are subjected the genetic analysis. Polymorphism of TNF-а gene in the position-308 G →A, also influence nucleotide substitutions by production level cytokine TNF-а; and also its contribution to development and an outcome nosocomial pneumonia. It is revealed that genetically programmed changed production TNF-а; namely hyperproduction at carring allele A of TNF-а gene, affects of current nosocomial pneumonia, frequency of joining of pulmonary complications and the raised secretion of C-reactive protein.

The occurrence, the course, and outcome of ventilator-associated pneumonia (VAP) related to Pseudomonas aeruginosa were prospectively followed up in 51 patients treated at an intensive care unit. The characteristic feature of P. aeruginosa-induced VAP was its severe course and poor prognosis (mortality was 38%). More than half of cases were found to have bilateral lung injury with the upper left lung being involved. Lung tissue destruction and edema were rather frequent complications. The predictors of death in VAP caused by P. aeruginosa are admission to an intensive care unit, septic shock, and infection.

One of the most important rules of conduct patients with nosocomial pneumonia is provision adequate antimicrobial regimens and reduction of irrational using the antibiotics at data categories of patients. In given article is shown that inadequate choice of start antimicrobial regimens is disadvantage influences upon factors mortality rates at patients of nosocomial pneumonia. Offered tactics of deescalated therapy in clinical researches proves the possibility of reduction of mortality rates at patients with nosocomial pneumonia in 2,5 times in contrast with other antimicrobial regimens.

This prospective study was focused on the initiation, development and outcome of nosocomial pneumonia (NP) caused by Pseudomonas aeruginosa in 51 patients receiving intensive therapy. The most characteristic features of this NP proved to be severe clinical course and poor prognosis (38% lethality). More than half of the cases developed bilateral lung disease with the predominant affection of the upper lobe in the left lung. Other frequent conditions were tissue destruction and oedema. The need of immediate hospitalization at the intensive therapy ward, septic shock, and infectious disease were predictors of fatal outcome of NP.

Изучена ассоциация полиморфизма гена рецептора CD14 в позиции С(-260)→Т с частотой возникновения, тяжестью течения и исходом нозокомиальной пневмонии (НП). Установлены ассоциации между исследованным полиморфизмом гена CD14 и клиническими проявлениями НП у 75 пациентов: генотип ТТ (но не аллель Т) коррелирует с повышенным риском развития НП, тяжестью ее проявлений и прогнозом. Выявленные ассоциации требуют дальнейшего изучения для объяснения метаболических и иммунологических нарушений у пациентов с НП.

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.