Update Pneumonie 2012

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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