Epidemiology and Infectious DiseasesEpidemiology and Infectious DiseasesЭпидемиология и инфекционные болезни3034-20073034-2015Eco-Vector4075810.17816/EID40758ArticlesСтатьиResearch ArticleNecrotizing pneumonia caused Staphylococcus aureusНекротизирующая пневмония, вызванная Staphylococcus aureusBeloborodovV. B.БелобородовВладимир Борисович

д-р мед. наук, проф. каф. инфекционных болезней

vb_be-loborodov@mail.ruFederal State Budgetary Institution Russian medical academy of postgraduate educationГБОУ ДПО «Российская медицинская академия последипломного образования»15042014192NO2 (2014)№2 (2014)41023072020Copyright ©; 2014, Eco-vectorCopyright ©; 2014, ООО "Эко-вектор"2014Eco-vectorООО "Эко-вектор"https://rjeid.com/1560-9529/article/view/40758

Necrotizing pneumonia caused by S. aureus is infrequent, but very serious illness with a high mortality. Pneumonia arises mainly in children and young adults, develops within several days is accompanied with multiple necroses in lung tissue, often leads to a lethal outcome. The feature ofpathogen is ability to formation ofpore-forming toxin destroying different cells in the body including polymorphonuclear leukocytes. The previous virus infection, for example flu, is considered a contributing factor or the co-infection which creates prerequisites for destruction ofneutrophils in lungs with appearance ofnecroses. S. aureus is not the most frequent causative agent of community-acquired pneumonia therefore empirical therapy does not include antibiotics with the activity against staphylococci which are sensitive or resistant to oxacyllin/meticyllin. As a result empirical regimen of antibacterial therapy appears not to be effective. Early clinical signs are a high fever, blood in the sputum, the presence of cavities in the lungs, a rapid increase in respiratory failure. The microscopy of sputum with detection o a large number of staphylococci allows to establish pathogen at an early stage, before obtaining results oif microbiological tests to prove application ofantibiotics active against staphylococci, and after receiving microbiological data to carry out the final correction ovf antibacterial therapy. Respiratory virus infection preceding peumonia or adverse epidemiological situation (flu epidemic) also is the justification for empiric application of anti-staphylococcal antibiotics in community acquired pneumonia.

Некротизирующая пневмония, вызванная S. aureus, является нечастым, но очень тяжелым заболеванием c высокой летальностью. Пневмония возникает преимущественно у детей и лиц молодого возраста, развивается в течение нескольких суток, сопровождается множественными некрозами ткани легкого и часто приводит к летальному исходу. Особенностью возбудителя является способность к образованию порообразующего токсина, повреждающего различные клетки организма, в том числе нейтрофилы. Считается, что предшествующая вирусная инфекция, например грипп, является предрасполагающим фактором или коинфекцией, создающими предпосылки для разрушения нейтро-филов в легких с возникновением некрозов. Стафилококки не являются наиболее частыми возбудителями внебольнич-ной пневмонии, поэтому режимы эмпирической терапии не включают препараты активные против чувствительных или резистентных к оксациллину/метициллину стафилококков. В результате эмпирический режим антибактериальной терапии оказывается неэффективным. Ранними клиническими признаками являются высокая лихорадка, кровь в мокроте, наличие полостей в легких, быстрое нарастание дыхательной недостаточности. Микроскопия мокроты с обнаружением большого количества стафилококков позволяет на раннем этапе установить этиологию возбудителя, до получения результатов посева обосновать применение препаратов, активных против стафилококков, а после получения микробиологических данных провести окончательную коррекцию антибактериальной терапии. Предшествующая пневмонии респираторная вирусная инфекция или неблагоприятная эпидемиологическая ситуация (эпидемия гриппа) также являются обоснованием для эмпирического применения антистафилококковых препаратов.

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