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Krankenhaushygiene up2date 2007; 2(4): 317-328
DOI: 10.1055/s-2007-995367
Nosokomiale Infektionen

© Georg Thieme Verlag KG Stuttgart · New York

Nosokomiale und beatmungsassoziierte Pneumonien

Tobias  Welte
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Publication History

Publication Date:
11 December 2007 (online)

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Kernaussagen

  • Die nosokomiale Pneumonie bleibt eine Erkrankung mit hoher Morbidität und Letalität.

  • Die primär adäquate Antibiotikatherapie - frühzeitig, breit und hochdosiert, an der lokalen Erregersituation orientiert - ist der entscheidende Faktor für eine erfolgreiche Therapie.

  • Die Risikofaktorenanalyse des Patienten (Vortherapie, Lebensraum, Begleiterkrankungen) fließt in die Therapieüberlegungen ein.

  • Grundsätzlich geeignet für eine empirische Initialtherapie sind Piperacillin (+ Inhibitor) und pseudomonaswirksame Cephlosporine sowie Carbapeneme.

  • Eine Kombinationstherapie mit Aminoglykosiden oder Fluorchinolonen ist möglich, jedoch nicht durch positive Studien belegt.

  • Vancomycin bleibt der Standard für die MRSA Therapie, mit Linezolid steht zumindestens für die schwere Infektion eine Alternative zur Verfügung.

  • Die Therapiedauer von sieben Tagen sollte nur in Einzelfällen überschritten werden.

  • Supportive Maßnahmen wie ausreichende Volumensubstitution, Thromboseprophylaxe und Sauerstoffgabe entsprechen allgemeinen Therapieprinzipien in der Therapie schwer kranker Patienten.

  • Ein Übergang einer nosokomialen Pneumonie in eine schwere Sepsis oder einen septischen Schock ist häufig und erfordert entsprechende therapeutische Maßnahmen.

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Prof. Dr. Tobias Welte

Medizinische Hochschule Hannover

Abteilung Pneumologie

Carl Neuberg Straße 1

30625 Hannover

Phone: 0511/532-3530

Fax: 0511/532-3353

Email: Welte.Tobias@mh-hannover.de

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