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Intensivmedizin und Notfallmedizin

, Volume 43, Issue 4, pp 301–309 | Cite as

Die nosokomiale Pneumonie

State-of-the-Art
  • T. Welte
BEITRAG ZUM THEMENSCHWERPUNKT

Zusammenfassung

Nosokomiale Pneumonie sind die häufigsten Intensivinfektionen mit hoher Morbidität und Letalität. Die primär inadäquate Antibiotikatherapie ist der entscheidende Faktor für Therapieversagen. Eine möglichst breite hochdosierte Initialtherapie ist daher zwingend erforderlich. Um die weitere Resistenzentwicklung zu vermeiden muss die Antibiotikatherapie frühzeitig evaluiert werden und in Abhängigkeit vom Therapieerfolg beendet oder gewechselt werden.

Deeskalationstherapie ab Tag 3 ist möglich und sinnvoll. Eine Therapiedauer von 7 Tagen sollte nur in Einzelfällen überschritten werden. Therapieempfehlungen müssen entsprechend der lokalen Resistenz- und Erregerstatistiken angepasst werden. Die Risikofaktorenanalyse des Patienten (Vortherapie, Lebensraum, Begleiterkrankungen) fließt in die Therapieüberlegungen ein.

Schlüsselwörter

Nosokomiale Pneumonie Diagnostik Therapie Antibiotika 

Management of nosocomial pneumonia—state of the art

Summary

Nosocomial pneumonia is among the most frequent infections in the intensive care unit with high morbidity and mortality. The decisive factor for treatment failure is inadequate previous antibiotic treatment. Broad spectrum and sufficiently high dosed initial treatment is crucial.

To prevent further resistances, the antibiotic treatment must be evaluated early. Depending on the treatment success, treatment has to be changed or terminated. Deescalation is possible and sensible after three days. A treatment period of seven days should not routinely be exceeded. The treatment recommendations should be adapted to local resistances and the local statistics of frequent pathogens. A further factor for treatment decision-making is the risk analysis of the patient (previous treatment, stays in hospitals or nursing homes, concomitant diseases).

Key words

Nosocomial pneumonia diagnosis therapy antibiotics 

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Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  1. 1.Abteilung PneumologieMedizinische Hochschule HannoverHannover

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