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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
› Institutsangaben
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Publikationsverlauf

28. März 2012

09. August 2012

Publikationsdatum:
23. Oktober 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
 

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