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Pneumologie 1999; 53(10): 499-510
DOI: 10.1055/s-1999-9044
EMPFEHLUNGEN
Georg Thieme Verlag Stuttgart ·New York

Deutsche Gesellschaft für Pneumologie

Empfehlungen zur Diagnostik der nosokomialen PneumonieS. Ewig1 , K. Dalhoff2 , J. Lorenz3 , H. Mauch4 , T. Schaberg5 , D. Ukena6 , T. Welte7 , H. Wilkens8 , Ch Witt9
  • 1Bonn (federführend)
  • 2Lübeck
  • 3Lüdenscheid
  • 4Berlin
  • 5Rotenburg
  • 6Homburg
  • 7Magdeburg
  • 8Homburg
  • 9Berlin
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Publication History

Publication Date:
31 December 1999 (online)

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Zusammenfassung:

Die klinischen Kriterien für das Vorliegen einer nosokomialen Pneumonie sind nur begrenzt sensitiv und spezifisch. Die Diagnostik der nosokomialen Pneumonie hat daher zum Ziel, das Vorliegen einer Pneumonie zu belegen und ursächliche Erreger zu identifizieren. Dabei ist die Identifikation des Erregers beim individuellen Patienten genauso wichtig wie die Erstellung lokaler Erreger- und Resistenzspektren. Zur Gewinnung von Sekreten des tiefen Respirationstraktes stehen nichtinvasive und invasive diagnostische Methoden zur Verfügung. Zumindest die mikrobiologische Basisdiagnostik sollte im Krankenhaus selbst durchgeführt werden. Die Technik der quantitativen Kultur von Sekreten des tiefen Respirationstrakts gewährleistet unabhängig von der eingesetzten Methode eine höhere Spezifität. Die nosokomiale Pneumonie des spontan atmenden Patienten kann in der Regel mittels klinischen und nichtinvasiven Methoden ausreichend valide diagnostiziert werden. Die nosokomiale Beatmungspneumonie hingegen bedarf zumindest in Krankenhäusern der Maximalversorgung einer Untersuchung durch die quantitative Kulturtechnik. Obwohl invasiv-bronchoskopische Techniken (besonders die geschützte Bürste PSB) tendenziell eine etwas bessere Spezifität aufweisen, sind sie hinsichtlich wichtiger klinischer Endpunkte dem quantitativ aufgearbeiteten Tracheobronchialsekret nicht überlegen. Als diagnostischer Grundansatz wird daher das quantitativ aufgearbeitete Tracheobronchialsekret empfohlen. Es sollte jedoch für spezielle Indikationen sowie die Abklärung von Therapieversagern mindestens eine bronchoskopische Technik etabliert sein. Auch nichtbronchoskopische Techniken der Gewinnung einer bronchoalveolären Lavage (z. B. „mini-BAL”) können in speziellen Indikationen hilfreich sein. Die Ergebnisse der quantitativen Kulturen sind in jedem Fall im Zusammenhang mit der klinischen Situation des Patienten zu interpretieren. Dabei ist insbesondere die Vortest-Wahrscheinlichkeit des Vorliegens einer Pneumonie zu berücksichtigen. Alle diagnostischen Ansätze erfordern eine intensive und enge Zusammenarbeit von Klinikern und Mikrobiologen. Regelmäßige Qualitätskontrollen sowie Aufstellungen des Erreger- und Sensibilitätsspektrums sind dabei unerläßlich.

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Dr. Priv.-Doz. S. Ewig

Medizinische Universitätsklinik und Poliklinik II Bonn

Sigmund-Freud-Str. 25

53105 Bonn