Zusammenfassung
30 Patienten mit malignen hämatologischen Erkrankungen und nosokomialer Pneumonie,
die während eines Zeitraums von drei Jahren auf der medizinischen Intensivstation
(ICU) eines Universitätsklinikums behandelt worden waren, wurden in einer retrospektiven
Studie untersucht. Zwölf dieser Patienten hatten eine Knochenmark- oder periphere
Stammzelltransplantation 90 ± 143 (10 - 546) Tage vor der Aufnahme auf die ICU erhalten.
Von ihnen erhielten sechs Ciclosporin A. 19 von 30 Patienten erhielten Corticosteroide,
20 hatten Zyklen von Chemotherapie innerhalb eines Zeitraums von einem Monat zuvor
erhalten. Die Patienten hatten bei der Aufnahme auf die ICU Zeichen einer pulmonalen
Infektion mit respiratorischer Insuffizienz. Bei 24 Patienten konnte ein Erregernachweis
geführt werden. Gramnegative Bakterien überwogen (n = 17), in der Mehrzahl Pseudomonas , Enterobacter und Klebsiella species. Grampositive Bakterien (n = 5) waren Streptococcus und Staphylococcus species. Infektionen mit Chlamydiae species wurden in zwei Fällen diagnostiziert. Pilzinfektionen waren durch Candida (n = 8) und Aspergillus species (n = 3) und virale Infektionen durch Cytomegalovirus (n = 6) verursacht worden. Infektionen mit mehr als einem Pathogen waren häufig.
Zehn Patienten hatten Zeichen einer diffusen pulmonalen Parenchymschädigung unterschiedlichen
Ausmaßes. 26 Patienten wurden maschinell über einen Zeitraum von 7 ± 9 (1 - 32) Tage
beatmet. Die Dauer des Aufenthaltes auf der ICU war 11 ± 10 (1 - 43) Tage. 26 von
30 Patienten (87 %) verstarben. Patienten mit malignen hämatologischen Erkrankungen
und nosokomialer Pneumonie haben trotz Intensivtherapie eine schlechte Prognose mit
erheblicher Letalität.
Abstract
30 patients with malignant haematological disorders and nosocomial pneumonia, treated
during a three-year period in the medical intensive care unit (ICU) of a university
hospital, were studied in retrospect. Twelve patients had received bone marrow or
peripheral stem cell transplantations 90 ± 143 (10 - 546) days prior to ICU admission.
Six of these received ciclosporin A. 19 of 30 patients were on corticosteroids and
20 had received courses of chemotherapy within a period of one month prior to ICU
admission. Patients presented with signs of pulmonary infection and respiratory failure.
In 24 patients the likely causative pathogen for pneumonia could be identified. Gram-negative
bacteriae (n = 17) were in the majority, lead by Pseudomonas , Enterobacter , and Klebsiella species . Gram-positive bacteriae (n = 5) were Streptococcus and Staphylococcus species . Infections with Chlamydiae species were diagnosed in two cases. Fungal infections were caused by Candida (n = 8) or Aspergillus species (n = 3) and viral infections by Cytomegalovirus (n = 6). Infections with more than one pathogen were common. Ten patients had pneumonia
associated with signs of diffuse pulmonary parenchymal damage of varying degree. 26
patients received mechanical ventilation for 7 ± 9 (1 - 32) days. The duration of
stay in the ICU was 11 ± 10 (1 - 43) days. 26 of the 30 patients (87 %) died. Patients
with haematological malignancies and nosocomial pneumonias have despite medical intensive
care treatment a poor prognosis with substantial mortality.
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Priv.-Doz. Dr. med. G. Hoheisel
August-Bebel-Str. 71
04275 Leipzig
eMail: gerhard.hoheisel@t-online.de