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DOI: 10.1055/s-0043-121734
Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie – Update 2017[*]
S3-Leitlinie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e.V., der Deutschen Gesellschaft für Infektiologie e.V., der Deutschen Gesellschaft für Hygiene und Mikrobiologie e.V., der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V., der Paul-Ehrlich Gesellschaft für Chemotherapie e.V, der Deutschen Röntgengesellschaft und der Gesellschaft für VirologieEpidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia – Update 2017S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for VirologyPublication History
Publication Date:
16 January 2018 (online)
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Zusammenfassung
Die nosokomiale Pneumonie bleibt eine häufige Komplikation von Krankenhausaufenthalten. Die meisten Daten liegen zur beatmungsassoziierten Pneumonie vor, aber auch auf Normalstationen ist vermehrt mit dieser Erkrankung zu rechnen. Problematisch ist die Zunahme von Infektionen mit multiresistenten Erregern (MRE). Diese erschwert die adäquate Initialtherapie und kann zu unkritischem Einsatz von Breitspektrumantibiotika führen.
Das vorliegende Update der S3-Leitlinie von 2012 wurde von einer interdisziplinären Arbeitsgruppe auf der Basis einer systematischen Literaturrecherche erarbeitet. Die Empfehlungen zu Diagnostik und Therapie wurden nach dem GRADE-System abgefasst. Graduierung und Empfehlungsstärke entsprechen der Methodik der Nationalen Versorgungsleitlinien.
Die Leitlinie besteht aus zwei Teilen. Der allgemeine Teil vermittelt einen aktuellen Überblick zu Epidemiologie, Erregerspektrum und Therapieoptionen der nosokomialen Pneumonie. Handlungsorientierte Empfehlungen zu Diagnostik und Therapie werden im zweiten Teil abgegeben. Neu in diesem Update sind detailliertere Empfehlungen zur bildgebenden Diagnostik, zur Diagnostik nosokomialer Virusinfektionen sowie zur prolongierten Applikation von Antiinfektiva. Die Angaben zur Bedeutung von Risikofaktoren für Infektionen mit MRE und die Empfehlungen zum Einsatz einer antibakteriellen Kombinationstherapie bei derartigen Infektionen wurden angepasst. Strukturierte Deeskalationskonzepte und eine konsequente Begrenzung der Therapiedauer zur Verminderung des Selektionsdrucks werden besonders betont.
Abstract
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.
This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.
This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.
* Verabschiedet von den Vorständen der beteiligten Fachgesellschaften am 11.9. 2017.
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