Pneumonien gehören zu den wichtigsten, nosokomial erworbenen Infektionen in Deutschland.
Rationale Strategien zur Diagnostik und Therapie können als Antibiotic-Stewardship-Maßnahmen
zur Optimierung der Behandlung und zur Minimierung der Resistenzentwicklung beitragen.
Eine kalkulierte antimikrobielle Therapie sollte den Schweregrad, das Risiko für multiresistente
Erreger und Pseudomonas aeruginosa sowie die lokale Resistenzsituation berücksichtigen.
Abstract
Pneumonia is one of the most important nosocomially acquired infections in Germany.
Rational management strategies contribute to optimizing treatment and minimizing the
development of resistance. The calculated antimicrobial therapy should take into account
the severity, the risk of multi-resistant pathogens and P. aeruginosa as well as the local resistance situation. The infection occurs more frequently in
non-ventilated patients, yet the evidence for ventilator-associated pneumonia is better,
mainly due to easier microbiological diagnostics. The spectrum of pathogens does not
differ significantly between the two disease entities. E. coli, K. pneumoniae, P. aeruginosa and, in the gram-positive spectrum, S. aureus and S. pneumoniae are the most common pathogens detected. Early detection, particularly in sepsis,
followed by targeted diagnostic measures are relevant managing the disease. Calculated
antibiotic therapy taking into account the severity of the disease and the patient's
individual risk of multi-resistant pathogens, should be administered promptly. A re-evaluation
of the diagnosis and therapy after 48–72 hours is crucial for the success of treatment
and the rational use of antibiotics. All findings obtained to confirm the diagnosis
and assess the course of the disease should be reviewed with regard to the accuracy
of the diagnosis, the therapeutic response and the possibility of optimizing antibiotic
therapy. If there is a response to treatment, which is primarily expressed in a clinical
improvement, the recommended treatment duration of 7 days should not be exceeded.
If there is no improvement in symptoms, microbiological findings, complications and
differential diagnoses should be checked. Pharmacokinetic and pharmacodynamic principles
should be considered with regard to the substances and the duration of application
and dosage.
Schlüsselwörter
Antibiotic Stewardship - nosokomiale Pneumonie - Antibiotikatherapie - Risikofaktoren
für MRE - Reevaluation
Keywords
antibiotic stewardship - nosocomial pneumonia - antibiotic treatment - reevaluation
- risk factors for MRE
