Pneumonie – Geschichtliche Entwicklung, Status quo und Ausblick

Zusammenfassung

Die Lungenentzündung (Pneumonie) ist eine der ältesten Erkrankungen der Menschheitsgeschichte mit einer hohen Morbidität und Letalität. Die Einführung der modernen Antibiotikatherapie hat daran nichts geändert, sondern im Gegenteil neue Probleme und Herausforderungen mit sich gebracht. Patienten werden älter und multimorbider, Erreger resistent gegen Antibiotika. Eine verbesserte Diagnostik und die Einführung risikostratifizierter Therapiemaßnahmen hat zu einer Vereinheitlichung der Therapie beigetragen. Impfstrategien haben sich für bestimmte Erreger bewährt. Während jahrzehntelang der Kampf gegen die Erreger im Vordergrund der Pneumoniebehandlung stand, spielt zunehmend die Abwehrlage des Menschen eine Rolle für die Forschung. Die Modulation des Immunsystems gilt als der wesentliche Ansatz, die Herausforderungen der Zukunft in der Infektiologie bewältigen zu können.

Abstract

Pneumonia is one of the oldest and best known diseases in mankind. Morbidity and mortality of this disease are remarkable. This has not been changed with the development of modern antibiotic therapy. On the contrary new challenges have arisen, more elderly and comorbid patients are involved and an increase in antibiotic resistance has appeared. An improvement in diagnosis and the introduction of risk stratification approaches has led to a standardisation in therapy. Vaccination strategies for special pathogens like S. pneumoniae have reduced the burden of disease. For decades research was focused on the development of new antibiotics. The failure of this strategy has directed more attention to the host-pathogen interaction. Modulation of innate immunity is one of the key issues to overcome the future challenges in this field.

Literatur

• 1 Horn E. Über die Erkenntnis und Heilung der Pneumonie. Frankfurt am Main; Friedrich Wilmans 1802
• 2 Tilghman R C, Finland M. Clinical significance of bacteremia in pneumococcic pneumonia.  Arch Intern Med. 1937;  59 602-619
• 3 Evans G M, Gaisford W F. Treatment of pneumonia with 2-(p-aminobenzenesulphonamid o) pyridine.  Lancet. 1938;  11 14-19
• 4 Welte T, Köhnlein T. Global and local epidemiology of community-acquired pneumonia: the experience of the CAPNETZ Network.  Semin Respir Crit Care Med. 2009;  30 127-135
• 5 Zuschneid I, Schwab F, Geffers C. et al . Trends in ventilator-associated pneumonia rates within the German nosocomial infection surveillance system (KISS).  Infect Control Hosp Epidemiol. 2007;  28 314-318
• 6 Schnoor M, Hedicke J, Dalhoff K. et al., CAPNETZ study group . Approaches to estimate the population-based incidence of community acquired pneumonia.  J Infect. 2007;  55 233-239
• 7 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
• 8 Ewig S, Welte T, Chastre J, Torres A. Rethinking the concepts of community-acquired and health-care-associated pneumonia.  Lancet Infect Dis. 2010;  10 279-287
• 9 George D L, Falk P S, Wunderink R G. et al . Epidemiology of ventilator acquired pneumonia based on protected bronchoscopic sampling.  Am J Respir Crit Care Med. 1998;  158 1839-1847
• 10 Garnacho-Montero J, Garcia-Garmendia J L, Barrero-Almodovar A. et al . Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis.  Crit Care Med. 2003;  31 2742-2751
• 11 Cosgrove S E. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs.  Clin Infect Dis. 2006;  42 (Suppl 2) S82-S89
• 12 Dietrich E S, Demmler M, Schulgen G. et al . Nosocomial pneumonia: a cost-of-illness analysis.  Infection. 2002;  30 61-67
• 13 Baum H von, Welte T, Marre R. et al., CAPNETZ study group . Community-acquired pneumonia through Enterobacteriaceae and Pseudomonas aeruginosa: Diagnosis, incidence and predictors.  Eur Respir J. 2010;  35 598-605
• 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
• 15 Rosenthal V D, Maki D G, Jamulitrat S. et al., INICC Members . International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003 – 2008, issued June 2009.  Am J Infect Control. 2010;  38 95-104
• 16 Hong T, Moland E S, Abdalhamid B. et al . Escherichia coli: development of carbapenem resistance during therapy.  Clin Infect Dis. 2005;  40 e84-e86
• 17 Namias N, Samiian L, Nino D. et al . Incidence and susceptibility of pathogenic bacteria vary between intensive care units within a single hospital: implications for empiric antibiotic strategies.  J Trauma. 2000;  49 638-645
• 18 Welte T. Die nosokomiale Pneumonie – State of the Art.  Intensivmedizin. 2006;  43 301-309
• 19 van der Eerden M M, Vlaspolder F, de Graaff C S. et al . Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study.  Thorax. 2005;  60 672-678
• 20 Fagon J Y, Chastre J, Wolff M. et al . Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial.  Ann Intern Med. 2000;  132 621-630
• 21 Canadian Critical Care Trials Group . A randomized trial of diagnostic techniques for ventilator-associated pneumonia.  N Engl J Med. 2006;  355 2619-2630
• 22 Maskell N A, Gleeson F V, Darby M. et al . Diagnostically significant variations in pleural fluid pH in loculated parapneumonic effusions.  Chest. 2004;  126 2022-2024
• 23 Bauer T T, Ewig S, Marre R. et al., CAPNETZ Study Group . CRB-65 predicts death from community-acquired pneumonia.  J Intern Med. 2006;  260 93-101
• 24 Höffken G, Lorenz J, Kern W. et al., Paul-Ehrlich-Gesellschaft für Chemotherapie; Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin; Deutschen Gesellschaft für Infektiologie und vom Kompetenznetzwerk CAPNETZ . Epidemiology, diagnosis, antimicrobial therapy and management of community-acquired pneumonia and lower respiratory tract infections in adults. Guidelines of the Paul-Ehrlich-Society for Chemotherapy, the German Respiratory Society, the German Society for Infectiology and the Competence Network CAPNETZ Germany.  Pneumologie. 2009;  63 e1-e68 und Pneumologie 2010; 64: 149 – 154
• 25 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
• 26 Valles J, Rello J, Ochagavia A. et al . Community-acquired bloodstream infection in critically ill adult patients: impact of shock and inappropriate antibiotic therapy on survival.  Chest. 2003;  123 1615-1624
• 27 Trouillet J L, Chastre J, Vuagnat A. et al . Ventilator-associated pneumonia caused by potentially drug-resistant bacteria.  Am J Respir Crit Care Med. 1998;  157 531-539
• 28 American Thoracic Society; Infectious Diseases Society of America . 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
• 29 Sandiumenge A, Diaz E, Bodi M, Rello J. Therapy of ventilator-associated pneumonia. A patient-based approach based on the ten rules of “The Tarragona Strategy”.  Intensive Care Med. 2003;  29 876-883
• 30 Bouadma L, Luyt C E, Tubach F. et al.; PRORATA trial group . Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial.  Lancet. 2010;  375 463-474
• 31 Paul M, Benuri-Silbiger I, Soares-Weiser K, Leibovici L. Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials.  BMJ. 2004;  328 668
• 32 Safdar N, Handelsman J, Maki D G. Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis.  Lancet Infect Dis. 2004;  4 519-527
• 33 Chamot E, Boffi E l, Amari E. et al . Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia.  Antimicrob Agents Chemother. 2003;  47 2756-2764
• 34 Heyland D K, Dodek P, Muscedere J. et al., Canadian Critical Care Trials Group . Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia.  Crit Care Med. 2008;  36 737-744
• 35 Jung Y J, Koh Y, Hong S B. et al . Effect of vancomycin plus rifampicin in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia.  Crit Care Med. 2010;  38 175-180
• 36 Falagas M E, Kasiakou S K, Kofteridis D P. et al . Effectiveness and nephrotoxicity of intravenous colistin for treatment of patients with infections due to polymyxin-only-susceptible (POS) gram-negative bacteria.  Eur J Clin Microbiol Infect Dis. 2006;  25 596-599
• 37 Gross P A, Hermogenes A W, Sacks H S. et al . The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature.  Ann Intern Med. 1995;  123 518-527
• 38 Maruyama T, Taguchi O, Niederman M S. et al . Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial.  BMJ. 2010;  340 c1004
• 39 Pletz M W, Maus U, Krug N. et al . Pneumococcal vaccines: mechanism of action, impact on epidemiology and adaption of the species.  Int J Antimicrob Agents. 2008;  32 199-206
• 40 Pittet D. Clean hands reduce the burden of disease.  Lancet. 2005;  366 185-187
• 41 Pobo A, Lisboa T, Rodriguez A. et al., RASPALL Study Investigators . A randomized trial of dental brushing for preventing ventilator-associated pneumonia.  Chest. 2009;  136 433-439
• 42 de Smet A M, Kluytmans J A, Cooper B S. et al . Decontamination of the digestive tract and oropharynx in ICU patients.  N Engl J Med. 2009;  360 20-31
• 43 Krüger S, Ewig S, Giersdorf S. et al., the CAPNETZ study group . Cardiovascular and Inflammatory Biomarkers to Predict Short- and Long-term Survival in Community-acquired Pneumonia.  Am J Respir Crit Care Med. 2010;  Jul 16 [Epub ahead of print]