[Severe community-acquired pneumonia: etiology].

A complex microbiological (sputum, protected brush biopsy of the bronchial mucosa) and immunological examination of 40 male patients (the average age of 55.4 +/- 8.8 years) with severe community-acquired pneumonia (risk classes III-V according to Fine M.J. et al., 1997) revealed the disease etiology in 52.5 per cent of the cases. The leading pathogen was Streptococcus pneumoniae. It was detected in 61.6 per cent of the cases of the etiologically verified pneumonia. Staphylococcus aureus and Klebsiella pneumoniae were also among the actual pathogens (14.3 and 14.3 per cent respectively). The Legionnaires infection was not confirmed in any of the patients (enzyme-linked immunological analysis of urine for the serotype 1-6 Legionella pneumophila antigen). In the absolute majority of the patients the isolated pneumococci were susceptible (E-test) to benzylpenicillin. Only in 1 patients with severe pneumonia and secondary bacteriemia the pneumococcal isolates were moderately resistant to benzylpenicillin (the MIC of 0.125 mg/ml). Still, they were susceptible to ceftriaxone (the MIC of 0.023 mg/ml). The data are useful in the development of a national (regional) programme for empirical antibacterial therapy of severe community-acquired pneumonia.