Nosokomiale Pneumonien – Teil 2: Präventionsmaßnahmen

Nosokomiale Pneumonien zählen nach wie vor zu den häufigsten Infektionen, die im Krankenhaus erworben werden. Während für Beatmungs-assoziierte Pneumonien zahlreiche Studien mit evidenzbasierten Empfehlungen vorliegen, ist die Datenlage zu nichtbeatmeten Patienten mit nosokomialer Pneumonie bezüglich Präventionsmaßnahmen mit nachgewiesener Wirksamkeit spärlich.

Schlüsselwörter

Pneumonie - Intensivstation - Probiotika - Chlorhexidin - Beatmung - nosokomiale Infektionen

• Literatur

• 1 Mastrogianni M, Katsoulas T, Galanis P. et al. The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review. Antibiotics 2023; 12: 227
• 2 Weinberger J, Cocoros N, Klompas M. Ventilator-Associated Events Epidemiology, Risk Factors, and Prevention. Infect Dis Clin N Am 2021; 35: 871-899
• 3 Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M. et al. Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program. Multicenter Study Crit Care Med 2018; 46: 181-188
• 4 Boudama L, Klompas M. Oral care with chlorhexidine: beware!. Intensive Care Med 2018; 44: 1153-1155
• 5 Klompas M, Branson R, Cawcutt K. et al. SHEA/IDSA/APIC Practice Recommendation. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 43: 687-713
• 6 Papazian L, Klompas M, Luyt CE. Ventilator‑associated pneumonia in adults: a narrative review. Intensive Care Med 2020; 46: 888-906
• 7 Klompas M, Speck K, Howell MD. et al. Reappraisal of Routine Oral Care With Chlorhexidine Gluconate for Patients Receiving Mechanical VentilationSystematic Review and Meta Analysis. JAMA Intern Med 2014; 174: 751-761
• 8 Mutters N, Neubert TR, Nieth R. et al. The role of Octenidol, Glandomed and chlorhexidine mouthwash in the prevention of mucositis and in the reduction of the oropharyngeal flora: a double-blind randomized controlled trial. GMS Hyg Infect Control 2015; 10: Doc05
• 9 Gupta A, Gupta A, Singh TK. et al. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients. Saudi J Anaesth 2016; 10: 95-97
• 10 Gregorczyk-Maga I, Pałka A, Fiema M. et al. Impact of tooth brushing on oral bacteriota and health care‑associated infections among ventilated COVID‑19 patients: an intervention study. Antimicrob Resist Infect Control 2023; 12: 17
• 11 Ehrenzeller S, Klompas M. Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia A Systematic Review and Meta-Analysis. JAMA Intern Med 2024; 184: 131-142
• 12 Candel FJ, Salavert M, Estella A. et al. Ten Issues to Update in Nosocomial or Hospital-Acquired Pneumonia: An Expert Review. J Clin Med 2023; 12: 6526
• 13 Myburgh JA, Seppelt IM, Goodman F. et al. SuDDICU Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group. Effect of Selective Decontamination of the Digestive Tract on Hospital Mortality in Critically Ill Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA 2022; 328: 1911-192
• 14 Hammond NE, Myburgh J, Seppelt I. et al. Association Between Selective Decontamination of the Digestive Tract and In-Hospital Mortality in Intensive Care Unit Patients Receiving Mechanical Ventilation: A Systematic Review and Meta-analysis. JAMA 2022; 328: 1922-1934
• 15 Wang B, Briegel J, Krueger WA. et al. Ecological effects of selective oral decontamination on multidrug-resistance bacteria acquired in the intensive care unit: a case-control study over 5 years. Intensive Care Med 2022; 48: 1165-1175
• 16 Saied I, Mourvillier B, Cohen Y. et al. A Comparison of the Mortality Risk Associated With Ventilator-Acquired Bacterial Pneumonia and Nonventilator ICU-Acquired Bacterial Pneumonia. Crit Care Med 2019; 47: 345-352
• 17 Bo L, Li J, Tao Y. et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev 2014; 25: CD009066
• 18 Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Prävention der nosokomialen beatmungsassoziierten Pneumonie. Bundesgesundheitsbl 2013; 56: 1578-1590
• 19 Cheema HA, Shahid A, Ayyan M. et al. Probiotics for the Prevention of Ventilator-Associated Pneumonia: An Updated Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2022; 14: 1600
• 20 Zhao J, Li LQ, Chen CY. et al. Do probiotics help prevent ventilatorassociated pneumonia in critically ill patients? A systematic review with meta-analysis. ERJ Open Res 2021; 7: 00302-2020
• 21 Maret-Ouda J, Panula J, Santoni G. et al. Proton pump inhibitor use and risk of pneumonia: a selfcontrolled case series study. J Gastroenterol 2023; 58: 734-740
• 22 Trifan A, Stanciu C, Girleanu I. et al. Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis. World J Gastroenterol 2017; 23: 6500-6651
• 23 Takaqi T, Naito Y, Inoue R. et al. The influence of long-term use of proton pump inhibitors on the gut microbiota: an age-sex-matched case-control study. J Clin Biochem Nutr 2018; 62: 100-105
• 24 Zhuo X, Pan L, Zeng X. The effects of the 45° semi-recumbent position on the clinical outcomes of mechanically ventilated patients: a systematic review and meta-analysis study. Ann Palliat Med 2021; 10 (10) 10643-10651
• 25 Wang L, Li X, Yang Z. et al. Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev 2016; 1: CD009946
• 26 Boden I, Skinner EH, Browning L. et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ 2018; 360
• 27 Yeu Pu C, Batarseh H, Zafron ML. et al. Effects of Preoperative Breathing Exercise on Postoperative Outcomes for Patients With Lung Cancer Undergoing Curative Intent Lung Resection: A Meta-analysis. Arch Phys Med Rehabil 2021; 102: 2416-2427.e4
• 28 Mao Z, Gao L, Wang G. et al. Subglottic secretion suction for preventing ventilator-associated pneumonia: an updated meta-analysis and trial sequential analysis. Crit Care 2016; 20: 353
• 29 Yiating L, Yaochen W. The association of subglottic secretion drainage and tracheal mucosa injury. ERJ Open Res 2020; 6: 27
• 30 Anand R. et al. Comparative Study of Effect of Continuous versus Intermittent Subglottic Suctioning by the Suction Above the Cuff Endotracheal Tube (SACETT) on Tracheal Mucosa and Incidence of VAP in Intensive Care Unit. J Card Crit Care 2021; 5: 196-200
• 31 Suys E, Nieboer K, Stiers W. et al. Intermittent subglottic secretion drainage may cause tracheal damage in patients with few oropharyngeal secretions. Intensive Crit Care Nurs 2013; 29: 317-320
• 32 Marjanovic N, Boisson M, Asehnoune K. et al. Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated The AGATE Multicenter Randomized Controlled Study. Chest 2021; 160: 499-508
• 33 Dat VQ, Yen LM, Loan HT. et al. Effectiveness of Continuous Endotracheal Cuff Pressure Control for the Prevention of Ventilator-Associated Respiratory Infections: An Open-Label Randomized, Controlled Trial. Clin Infect Dis 2022; 74: 1795-1803
• 34 Assanga PA, AmugutsiIsiaho L. Effects of Open and Closed Tracheal Suction Systems on the Incidence of Ventilator Associated Events. A Systematic Review. ARC J Nurs Healthcare 2018; 4: 3-8
• 35 Jakisch J, Rettkowski R. SOP Endotracheales Absaugen – unter Beteiligung der Hygiene. Krankenhaushygiene up2date 2017; 12: 9-13
• 36 Jongerden IP, Buiting AG, Leverstein-van Hall MA. et al. Effect of open and closed endotracheal suctioning on cross-transmission with Gram-negative bacteria: a prospective crossover study. Crit Care Med 2011; 39: 1313-1321
• 37 AWMF. S3-Leitlinie „Invasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz“, 1. Aufl., Langversion, Stand 04.12.2017, AWMF-Registernr. 0101021.
• 38 Wolfensberger A, Clack L, von Felten S. et al. Implementation and evaluation of a care bundle for prevention of non-ventilatorassociatedhospital-acquired pneumonia (nvHAP) – a mixed-methods study protocol for a hybrid type 2effectivenessimplementation trial. BMC Infect Dis 2020; 20: 603
• 39 Giuliano K, Penoyer D, Middleton A. et al. Oral Care als Prevention for Nonventilator Hospital-Acquired Pneumonia. Am J Nurs 2021; 121
• 40 Baker D, Quinn B. Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control 2018; 46: 2-7
• 41 Quinn B, Giuliano KK, Baker D. Non-ventilator health care-associated pneumonia (NV-HAP): Best practices for prevention of NV-HAP. Am J Infect Control 2020; 48: A23−A27
• 42 Tazreean R, Nelson G, Twomey R. Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements. J Comp Eff Res 2022; 11: 121-129
• 43 PARI. PEP-Atmung und PEP Systeme – Was ist das und was bringt es?. Zugriff am 19. Februar 2024 unter: www.pari.com/de/blog/pep-atmung-und-pep-systeme-was-ist-das-und-was-bringt-es/
• 44 Wirth R, Dziewas R, Jäger M. et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE, der DGN und der DGG Klinische Ernährung in der Neurologie – Teil des laufenden S3-Leitlinienprojekts Klinische Ernährung. Zugriff am 19. Februar 2024 unter: www.dgem.de/sites/default/files/PDFs/Leitlinien/Leitlinie_Neurologie_2018.pdf