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Dtsch Med Wochenschr 2012; 137(44): 2265-2284
DOI: 10.1055/s-0032-1305297
CME | Review article
Pneumologie
© Georg Thieme Verlag KG Stuttgart · New York

Update Pneumonie 2012

Update Pneumonia 2012
M. W. Pletz
1   Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena
2   Integriertes Forschungs- und Behandlungszentrum (IFB) Sepsis und Sepsisfolgen (Center for Sepsis Control and Care), Universitätsklinikum Jena
,
S. Ewig
3   Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Ev. Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum
,
C. Lange
4   Klinische Infektiologie, Forschungszentrum Borstel
,
T. Welte
5   Klinik für Pneumologie, Medizinische Hochschule Hannover
,
G. Höffken
6   Medizinische Klinik I – Pneumologie, Universitätsklinikum Carl Gustav Carus Dresden
› Author Affiliations
Further Information

Publication History

28 March 2012

09 August 2012

Publication Date:
23 October 2012 (online)

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Zusammenfassung

Die Pneumonie ist eine Infektion des Lungenparenchyms und klinisch definiert durch ein neu aufgetretenes radiologisch nachweisbares Infiltrat mit entsprechender klinischer Symptomatik. Es werden drei verschiedene Formen der Pneumonie unterschieden: die ambulant erworbene Pneumonie (engl. community-acquired pneumonia, CAP), die nosokomiale Pneumonie (engl. hospital-acquired pneumonia, HAP) sowie die Pneumonie unter Immunsuppression. Das Erregerspektrum wird von CAP, bei der v. a. Pneumokokken dominieren, über HAP (zusätzlich multiresistente Erreger) bis zur Pneumonie unter Immunsuppression (zusätzlich opportunistische Erreger) vielfältiger. Entsprechend fordert jede der o. g. Entitäten spezifische diagnostische Maßnahmen sowie eine spezifische kalkulierte anti-infektive Therapie. In der vorlegenden Übersicht, werden die 3 Entitäten gegenübergestellt und das klinische Vorgehens basierend auf den derzeitigen Leitlinien und aktuellen Studien zusammenfassend dargestellt.

Abstract

Pneumonia is an infection of the lung parenchyma and defined as combination of a novel radiological infiltrate with typical signs and symptoms. There are 3 distinguished entities of pneumonia: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and pneumonia in the immunocompromised patient. The spectrum of pathogens is increasing from CAP, mostly caused by pneumococci, over HAP (additional multi-drug resistant pathogens) to pneumonia in the immunocompromised (additional opportunistic pathogens). Therefore, each entity demands a specific diagnostic and therapeutic approach. This review compares the 3 forms of pneumonia and presents a guideline based clinical approach in the context of current studies.

Schlüsselwörter

Leitlinie - Immunsuppression - nosokomiale Pneumonie - ambulant erworbene Pneumonie - Prophylaxe - Antibiotika - Resistenz

Keywords

guideline - Immunosuppression - hospital-acquired pneumonia - community-acquired pneumonia - prophylaxis - antibiotics - resistance
 

  • Literatur

  • 1 Ascioglu S, Rex JH, de Pauw B et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7-14
    CrossrefPubMedSearch in Google Scholar
  • 2 ATS. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388-416
    CrossrefPubMedSearch in Google Scholar
  • 3 Benito N, Moreno A, Miro JM et al. Pulmonary Infections in HIV-Infected Patients: An Update inthe 21st Century. Eur Respir J 2012; 39: 730-745
    CrossrefPubMedSearch in Google Scholar
  • 4 Bernatsky S, Hudson M, Suissa S. Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology (Oxford) 2007; 46: 1157-1160
    CrossrefPubMedSearch in Google Scholar
  • 5 Chastre J, Wolff M, Fagon JY et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003; 290: 2588-2598
    CrossrefPubMedSearch in Google Scholar
  • 6 Curtis JR, Xie F, Chen L et al. The comparative risk of serious infections among rheumatoid arthritis patients starting or switching biological agents. Ann Rheum Dis 2011; 70: 1401-1406
    CrossrefPubMedSearch in Google Scholar
  • 7 Dalhoff K, Marxsen J, Steinhoff J. Pneumonien bei Immunsuppression. Internist (Berl) 2007; 48: 507-508, 510-508
    CrossrefPubMedSearch in Google Scholar
  • 8 Dennesen PJ, van der Ven AJ, Kessels AG et al. Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med 2001; 163: 1371-1375
    CrossrefPubMedSearch in Google Scholar
  • 9 Ewig S, Birkner N, Strauss R et al. New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax 2009; 64: 1062-1069
    CrossrefPubMedSearch in Google Scholar
  • 10 Ewig S, Klapdor B, Pletz MW et al. Nursing-home-acquired pneumonia in Germany: an 8-year prospective multicentre study. Thorax 2012; 67: 132-138
    CrossrefPubMedSearch in Google Scholar
  • 11 Ewig S, Welte T, Chastre J et al. Rethinking the concepts of community-acquired and health-care-associated pneumonia. Lancet Infect Dis 2010; 10: 279-287
    CrossrefPubMedSearch in Google Scholar
  • 12 Freire AT, Melnyk V, Kim MJ et al. Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagn Microbiol Infect Dis 2010; 68: 140-151
    CrossrefPubMedSearch in Google Scholar
  • 13 Garnacho-Montero J, Sa-Borges M, Sole-Violan J et al. Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: an observational, multicenter study comparing monotherapy with combination antibiotic therapy. Crit Care Med 2007; 35: 1888-1895
    CrossrefPubMedSearch in Google Scholar
  • 14 Gastmeier P, Sohr D, Geffers C et al. Early- and late-onset pneumonia: is this still a useful classification?. Antimicrob Agents Chemother 2009; 53: 2714-2718
    CrossrefPubMedSearch in Google Scholar
  • 15 Guo YL, Chen YQ, Wang K et al. Accuracy of BAL galactomannan in diagnosing invasive aspergillosis: a bivariate metaanalysis and systematic review. Chest 2010; 138: 817-824
    CrossrefPubMedSearch in Google Scholar
  • 16 Hirsch EB, Tam VH. Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): an emerging cause of multidrug-resistant infection. J Antimicrob Chemother 2010; 65: 1119-1125
    CrossrefPubMedSearch in Google Scholar
  • 17 Hodinka RL. Human Cytomegalovirus. In: Murray PR, Hrsg. Manual of Clinical Microbiology. . 8.. Aufl. Washington: ASM Press; 2003: 1304-1318
    Search in Google Scholar
  • 18 Höffken G, Lorenz J, Kern W et al. Kurzfassung der S3-Leitlinie zu ambulant erworbenen unteren Atemwegsinfektionen sowie zu ambulant erworbener Pneumonie bei Erwachsenen. Dtsch Med Wochenschr 2010; 135: 359-365
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Jung YJ, Koh Y, Hong SB et al. Effect of vancomycin plus rifampicin in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia. Crit Care Med 2010; 38: 175-180
    CrossrefPubMedSearch in Google Scholar
  • 20 Kett DH, Cano E, Quartin AA et al. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis 2011; 11: 181-189
    CrossrefPubMedSearch in Google Scholar
  • 21 Keyser FD. Choice of Biologic Therapy for Patients with Rheumatoid Arthritis: The Infection Perspective. Curr Rheumatol Rev 2011; 7: 77-87
    CrossrefPubMedSearch in Google Scholar
  • 22 Kohlenberg A, Schwab F, Behnke M et al. Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Med 2010; 36: 971-978
    CrossrefPubMedSearch in Google Scholar
  • 23 Kwetkat A, Hagel S, Pletz MW. Impfungen im Alter. Pneumologe 2012; 9: 351-358
    CrossrefPubMedSearch in Google Scholar
  • 24 Lisboa T, Seligman R, Diaz E et al. C-reactive protein correlates with bacterial load and appropriate antibiotic therapy in suspected ventilator-associated pneumonia. Crit Care Med 2008; 36: 166-171
    CrossrefPubMedSearch in Google Scholar
  • 25 Liu C, Bayer A, Cosgrove SE et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 2011; 52: 285-292
    CrossrefPubMedSearch in Google Scholar
  • 26 Martin-Pena A, Aguilar-Guisado M, Espigado I et al. Prospective study of infectious complications in allogeneic hematopoietic stem cell transplant recipients. Clin Transplant 2011; 25: 468-474
    CrossrefPubMedSearch in Google Scholar
  • 27 Maschmeyer G, Beinert T, Buchheidt D et al. Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients: Guidelines of the infectious diseases working party of the German Society of Haematology and Oncology. Eur J Cancer 2009; 45: 2462-2472
    CrossrefPubMedSearch in Google Scholar
  • 28 Meersseman W, Lagrou K, Maertens J et al. Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med 2008; 177: 27-34
    CrossrefPubMedSearch in Google Scholar
  • 29 Meersseman W, Lagrou K, Spriet I et al. Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective, autopsy study. Intensive Care Med 2009; 35: 1526-1531
    CrossrefPubMedSearch in Google Scholar
  • 30 Melsen WG, Rovers MM, Bonten MJ. Ventilator-associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med 2009; 37: 2709-2718
    CrossrefPubMedSearch in Google Scholar
  • 31 Meyer E, Schwab F, Schroeren-Boersch B et al. Dramatic increase of third-generation cephalosporin-resistant E. coli in German intensive care units: secular trends in antibiotic drug use and bacterial resistance, 2001 to 2008. Crit Care 2010; 14: R113
    CrossrefPubMedSearch in Google Scholar
  • 32 Mueller NJ. New immunosuppressive strategies and the risk of infection. Transpl Infect Dis 2008; 10: 379-384
    CrossrefPubMedSearch in Google Scholar
  • 33 Pletz MW, Maus U, Hohlfeld JM et al. Pneumokokkenimpfung: Konjugatimpfstoff induziert Herdenimmunitat und reduziert Antibiotikaresistenz. Dtsch Med Wochenschr 2008; 133: 358-362
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Pletz MW, McGee L, Burkhardt O et al. Ciprofloxacin treatment failure in a patient with resistant Streptococcus pneumoniae infection following prior ciprofloxacin therapy. Eur J Clin Microbiol Infect Dis 2005; 24: 58-60
    CrossrefPubMedSearch in Google Scholar
  • 35 Pletz MW, Rohde G, Schutte H et al. Epidemiologie und Erreger bei ambulant erworbener Pneumonie (CAP). Dtsch Med Wochenschr 2011; 136: 775-780
    Thieme ConnectPubMedSearch in Google Scholar
  • 36 Pletz MW, van der Linden M, von Baum H et al. Low prevalence of fluoroquinolone resistant strains and resistance precursor strains in Streptococcus pneumoniae from patients with community-acquired pneumonia despite high fluoroquinolone usage. Int J Med Microbiol 2011; 301: 53-57
    CrossrefPubMedSearch in Google Scholar
  • 37 Rello J, Chastre J, Cornaglia G et al. A European care bundle for management of ventilator-associated pneumonia. J Crit Care 2010; 26: 3-10
    PubMedSearch in Google Scholar
  • 38 Schnoor M, Hedicke J, Dalhoff K et al. Approaches to estimate the population-based incidence of community acquired pneumonia. J Infect 2007; 55: 233-239
    CrossrefPubMedSearch in Google Scholar
  • 39 Schnoor M, Klante T, Beckmann M et al. Risk factors for community-acquired pneumonia in German adults: the impact of children in the household. Epidemiol Infect 2007; 135: 1389-1397
    PubMedSearch in Google Scholar
  • 40 Segal BH. Aspergillosis. N Engl J Med 2009; 360: 1870-1884
    CrossrefPubMedSearch in Google Scholar
  • 41 Seligman R, Meisner M, Lisboa TC et al. Decreases in procalcitonin and C-reactive protein are strong predictors of survival in ventilator-associated pneumonia. Crit Care 2006; 10: R125
    CrossrefPubMedSearch in Google Scholar
  • 42 Sopena N, Sabria M. Multicenter study of hospital-acquired pneumonia in non-ICU patients. Chest 2005; 127: 213-219
    CrossrefPubMedSearch in Google Scholar
  • 43 STIKO. Stellungnahme zur Impfung Erwachsener gegen Pneumokokken. Epidemiologisches Bulletin 2012; 55-56
    PubMedSearch in Google Scholar
  • 44 Stolz D, Christ-Crain M, Gencay MM et al. Diagnostic value of signs, symptoms and laboratory values in lower respiratory tract infection. Swiss Med Wkly 2006; 136: 434-440
    PubMedSearch in Google Scholar
  • 45 Strassburg A, Dalhoff K, Engelmann I et al. Infektionsdiagnostik in der Pneumologie. Pneumologie 2010; 64: 474-487
    Thieme ConnectPubMedSearch in Google Scholar
  • 46 Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis 1989; 11: 954-963
    CrossrefPubMedSearch in Google Scholar
  • 47 Tessmer A, Welte T, Martus P et al. Impact of intravenous {beta}-lactam/macrolide versus {beta}-lactam monotherapy on mortality in hospitalized patients with community-acquired pneumonia. J Antimicrob Chemother 2009; 63: 1025-1033
    CrossrefPubMedSearch in Google Scholar
  • 48 van den Berg JM, van Koppen E, Ahlin A et al. Chronic granulomatous disease: the European experience. PLoS ONE 2009; 4: e5234
    CrossrefPubMedSearch in Google Scholar
  • 49 Van der Linden M, Siedler A, von Kries R et al. Effects of Four Years of PCV7 Immunization in German Children on Numbers of Reported Cases and on Incidence of IPD. Boston: 50th Interscience Conference on Antibicrobial Agents and Chemotherapy. September 12-15, 2010. 2010
    PubMedSearch in Google Scholar
  • 50 Viasus D, Garcia-Vidal C, Castellote J et al. Community-acquired pneumonia in patients with liver cirrhosis: clinical features, outcomes, and usefulness of severity scores. Medicine (Baltimore) 2011; 90: 110-118
    CrossrefPubMedSearch in Google Scholar
  • 51 Viasus D, Garcia-Vidal C, Cruzado JM et al. Epidemiology, clinical features and outcomes of pneumonia in patients with chronic kidney disease. Nephrol Dial Transplant 2011; 26: 2899-2906
    CrossrefPubMedSearch in Google Scholar
  • 52 von Baum H, Ewig S, Marre R et al. Community-acquired Legionella pneumonia: new insights from the German competence network for community acquired pneumonia. Clin Infect Dis 2008; 46: 1356-1364
    CrossrefPubMedSearch in Google Scholar
  • 53 von Baum H, Schweiger B, Welte T et al. How deadly is seasonal influenza associated pneumonia? The German Competence Network for Community-acquired pneumonia (CAPNETZ). Eur Respir J 2011; 37: 1151-1157
    CrossrefPubMedSearch in Google Scholar
  • 54 von Baum H, Welte T, Marre R et al. Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ). BMC Infect Dis 2009; 9: 62
    CrossrefPubMedSearch in Google Scholar
  • 55 Wallis RS. Infectious complications of tumor necrosis factor blockade. Curr Opin Infect Dis 2009; 22: 403-409
    CrossrefPubMedSearch in Google Scholar
  • 56 Wellinghausen N, Straube E, Freidank H et al. Low prevalence of Chlamydia pneumoniae in adults with community-acquired pneumonia. Int J Med Microbiol 2006; 296: 485-491
    CrossrefPubMedSearch in Google Scholar
  • 57 Woodhead M. Community-acquired pneumonia guidelines – an international comparison: a view from Europe. Chest 1998; 113: 183S-187S
    CrossrefPubMedSearch in Google Scholar
  • 58 Wunderink RG, Niederman MS, Kollef MH et al. Linezolid in Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia: A Randomized, Controlled Study. Clin Infect Dis 2012; 54: 621-629
    CrossrefPubMedSearch in Google Scholar
  • 59 Yu VL, Chiou CC, Feldman C et al. An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis 2003; 37: 230-237
    CrossrefPubMedSearch in Google Scholar