Aktuelle Diagnostik der ambulant erworbenen Pneumonie

Zusammenfassung

Eine definitive Diagnose einer ambulant erworbenen Pneumonie ist entscheidend, um rechtzeitig die entsprechende Therapie und Versorgung einzuleiten. Häufiger dient die Diagnostik aber dem Ausschluss einer Pneumonie, um unnötige Antibiotikagaben zu vermeiden. Goldstandard in der Diagnosestellung ist in Zusammenhang mit anamnestischen und klinischen Befunden weiterhin die Röntgenaufnahme der Thoraxorgane. Moderne Entzündungsmarker wie das C-reaktive Protein und in Zukunft möglicherweise das Prokalzitonin helfen in der Differenzialdiagnose und Verlaufsuntersuchung. Eine mikrobiologische Erregerdiagnostik wird bei ambulant behandelten Patienten in der Regel nicht empfohlen. Bei hospitalisierten Patienten hat neben der klassischen Kultur der Urinantigen-Test auf Legionellen einen besonderen Stellenwert. Andere mikrobiologische Verfahren sind hingegen nur für Einzelfälle und Epidemien sinnvoll.

Literatur

• 1 Höffken G, Lorenz J, Kern W. et al . S3-guideline on ambulant acquired pneumonia and deep airway infections.  Pneumologie. 2005;  59 612-664
• 2 Metlay J P, Schulz R, Li Y H. et al . Clinical prediction rule for pulmonary infiltrates.  Ann Intern Med. 1990;  113 664-670
• 3 Young M, Marrie T J. Interobserver variability in the interpretation of chest roentgenograms of patients with possible pneumonia.  Arch Intern Med. 1994;  154 2729-2732
• 4 Kauppinen M T, Lahde S, Syrjala H. Roentgenographic findings of pneumonia caused by Chlamydia pneumoniae. A comparison with streptococcus pneumonia.  Arch Intern Med. 1996;  156 1851-1856
• 5 Garcia-Ordonez M A, Garcia-Jimenez J M. et al . Clinical aspects and prognostic factors in elderly patients hospitalised for community-acquired pneumonia.  Eur J Clin Microbiol Infect Dis. 2001;  20 14-19
• 6 Woodhead M A, Macfarlane J T, McCracken J S. et al . Prospective study of the aetiology and outcome of pneumonia in the community.  Lancet. 1987;  1 671-674
• 7 Syrjala H, Broas M, Suramo I. et al . High-resolution computed tomography for the diagnosis of community-acquired pneumonia.  Clin Infect Dis. 1998;  27 358-363
• 8 Fine M J, Smith M A, Carson C A. et al . Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis.  JAMA. 1996;  275 134-141
• 9 Almirall J, Bolibar I, Toran P. et al . Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia.  Chest. 2004;  125 1335-1342
• 10 Hopstaken R M, Muris J W, Knottnerus J A. et al . Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection.  Br J Gen Pract. 2003;  53 358-364
• 11 Hansson L O, Hedlund J U, Ortqvist A B. Sequential changes of inflammatory and nutritional markers in patients with community-acquired pneumonia.  Scand J Clin Lab Invest. 1997;  57 111-118
• 12 Castro-Guardiola A, Armengou-Arxe A, Viejo-Rodriguez A. et al . Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward.  Eur J Intern Med. 2000;  11 334-339
• 13 Garcia Vazquez E, Martinez J A, Mensa J. et al . C-reactive protein levels in community-acquired pneumonia.  Eur Respir J. 2003;  21 702-705
• 14 Seppa Y, Bloigu A, Honkanen P O. et al . Severity assessment of lower respiratory tract infection in elderly patients in primary care.  Arch Intern Med. 2001;  161 2709-2713
• 15 Muller C A, Uhl W, Printzen G. et al . Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis.  Gut. 2000;  46 233-238
• 16 Christ-Crain M, Jaccard-Stolz D, Bingisser R. et al . Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial.  Lancet. 2004;  363 600-607
• 17 Dalhoff K, Ewig S, Höffken G. et al . Recommendations for the diagnosis, therapy and prevention of pneumonia in the immunocompromised host.  Pneumologie. 2002;  56 807-831
• 18 Reed W W, Byrd G S, Gates Jr  R H. et al . Sputum gram's stain in community-acquired pneumococcal pneumonia. A meta-analysis.  West J Med. 1996;  165 197-204
• 19 Bartlett J G. Decline in microbial studies for patients with pulmonary infections.  Clin Infect Dis. 2004;  39 170-172
• 20 Theerthakarai R, El-Halees W, Ismail M. et al . Nonvalue of the initial microbiological studies in the management of nonsevere community-acquired pneumonia.  Chest. 2001;  119 181-184
• 21 Garcia-Vazquez E, Marcos M A, Mensa J. et al . Assessment of the usefulness of sputum culture for diagnosis of community-acquired pneumonia using the PORT predictive scoring system.  Arch Intern Med. 2004;  164 1807-1811
• 22 Roson B, Carratala J, Verdaguer R. et al . Prospective study of the usefulness of sputum Gram stain in the initial approach to community-acquired pneumonia requiring hospitalization.  Clin Infect Dis. 2000;  31 869-874
• 23 Waterer G W, Wunderink R G. The influence of the severity of community-acquired pneumonia on the usefulness of blood cultures.  Respir Med. 2001;  95 78-82
• 24 Corbo J, Friedman B, Bijur P. et al . Limited usefulness of initial blood cultures in community acquired pneumonia.  Emerg Med J. 2004;  21 446-448
• 25 Roson B, Fernandez-Sabe N, Carratala J. et al . Contribution of a urinary antigen assay (Binax NOW) to the early diagnosis of pneumococcal pneumonia.  Clin Infect Dis. 2004;  38 222-226
• 26 Gutierrez F, Masia M, Rodriguez J C. et al . Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain.  Clin Infect Dis. 2003;  36 286-292
• 27 Murdoch D R, Laing R T, Cook J M. The NOW S. pneumoniae urinary antigen test positivity rate 6 weeks after pneumonia onset and among patients with COPD.  Clin Infect Dis. 2003;  37 153-154
• 28 Helbig J H, Uldum S A, Bernander S. et al . Clinical utility of urinary antigen detection for diagnosis of community-acquired, travel-associated, and nosocomial legionnaires' disease.  J Clin Microbiol. 2003;  41 838-840
• 29 Lim W S, Macfarlane J T, Boswell T C. et al . Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines.  Thorax. 2001;  56 296-301
• 30 Lindsay D S, Abraham W H, Findlay W. et al . Laboratory diagnosis of legionnaires' disease due to Legionella pneumophila serogroup 1: comparison of phenotypic and genotypic methods.  J Med Microbiol. 2004;  53 183-187
• 31 Beersma M F, Dirven K, Dam A P van. et al . Evaluation of 12 commercial tests and the complement fixation test for Mycoplasma pneumoniae-specific immunoglobulin G (IgG) and IgM antibodies, with PCR used as the “gold standard”.  J Clin Microbiol. 2005;  43 2277-2285
• 32 Templeton K E, Scheltinga S A, Graffelman A W. et al . Comparison and evaluation of real-time PCR, real-time nucleic acid sequence-based amplification, conventional PCR, and serology for diagnosis of Mycoplasma pneumoniae.  J Clin Microbiol. 2003;  41 4366-4371