Poltava State Medical University, Poltava.
Kyiv City Clinical Hospital №17, Department of Clinical Pulmonology, Kyiv.
Acta Biomed. 2022 May 11;93(2):e2022238. doi: 10.23750/abm.v93i2.13137.
Empiric therapy of community-acquired pneumonia (CAP) remains the standard care and guidelines are mostly based on published data from the United States or Europe. In this study, we determined the bacterial etiology of CAP and evaluated the clinical outcomes under antimicrobial treatment of CAP in Ukraine.
A total of 98 adult subjects with CAP and PORT risk II-IV were recruited for the study. The sputum diagnostic samples were obtained from all patients for causative pathogen identification. Subjects were randomly assigned in a 1:1 ratio to receive delafloxacin 300 mg (n=51) or moxifloxacin 400 mg (n=47) with blinding placebo. The switch to oral treatment was after a minimum of 6 IV doses according to clinical criteria. The total duration of antibacterial treatment was 5-10 days. In vitro susceptibility of pathogens to delafloxacin and other comparator antibiotics was determined.
The most frequently isolated pathogens in adults with CAP were S. pneumoniae - 19.5%, M. pneumoniae - 15.3%, H. influenzae - 13.2%, S. aureus - 10.5%, K. pneumoniae - 10.1%, and H. parainfluenzae - 6.4%. All isolates of S. pneumoniae, S. aureus, M. pneumoniae had sufficient susceptibility to appropriate antibiotics. 9.0% of H. influenzae strains were susceptible to azithromycin. 94.8 % of patients had a successful clinical response to delafloxacin at the end of treatment and 93.9 % - at test-of-cure.
In Ukraine, the major bacterial agents that induced CAP in adults were S. pneumoniae, M. pneumoniae, H. influenzae, S. aureus, K. pneumoniae, H. parainfluenzae, E. cloacae, L. pneumophila. Delafloxacin is a promising effective antibiotic for monotherapy for CAP in adults and could be used in cases of antimicrobial-resistant strains.
社区获得性肺炎（CAP）的经验性治疗仍然是标准治疗，指南主要基于来自美国或欧洲的已发表数据。在这项研究中，我们确定了 CAP 的细菌病因，并评估了乌克兰 CAP 患者在抗菌治疗下的临床结局。
共招募了 98 名患有 CAP 和 PORT 风险 II-IV 的成年患者进行研究。所有患者均获得痰诊断样本以确定病原体。患者以 1:1 的比例随机分为接受德拉沙星 300mg（n=51）或莫西沙星 400mg（n=47）治疗的两组，并采用双盲安慰剂对照。根据临床标准，至少静脉注射 6 剂后才可转为口服治疗。抗菌治疗的总疗程为 5-10 天。测定病原体对德拉沙星和其他比较抗生素的体外药敏性。
成人 CAP 中最常分离的病原体为肺炎链球菌-19.5%，肺炎支原体-15.3%，流感嗜血杆菌-13.2%，金黄色葡萄球菌-10.5%，肺炎克雷伯菌-10.1%，副流感嗜血杆菌-6.4%。所有肺炎链球菌、金黄色葡萄球菌、肺炎支原体的分离株对适当的抗生素均具有足够的敏感性。9.0%的流感嗜血杆菌菌株对阿奇霉素敏感。94.8%的患者在治疗结束时对德拉沙星有成功的临床反应，93.9%在治疗后有成功的临床反应。
在乌克兰，引起成人 CAP 的主要细菌病原体为肺炎链球菌、肺炎支原体、流感嗜血杆菌、金黄色葡萄球菌、肺炎克雷伯菌、副流感嗜血杆菌、阴沟肠杆菌、嗜肺军团菌。德拉沙星是治疗成人 CAP 的一种有前景的有效单药抗生素，可用于治疗耐药菌株。
