Zusammenfassung
Pneumonien gelten als häufigste auf der Intensivstation erworbene Infektion. Sie sind mit einer hohen Letalität verknüpft und führen bei den überlebenden Patienten zu einer deutlichen Verlängerung der Liegedauer im Krankenhaus.Für epidemiologische Studien ist die Diagnose der Pneumonie durch klinisch-radiologische Kriterien klar definiert. Bei beatmeten Patienten liegt aber nur in ca. der Hälfte der Fälle tatsächlich eine Pneumonie vor, wenn sich im Röntgenbild Infiltrate in Verbindung mit eitrigem Trachealsekret, Fieber und Leukozytose zeigen. Diese klinischen Kriterien müssen daher als Screening untersuchung verstanden werden. Meist lassen sich die Pneumonieerreger im Trachealsekret nachweisen, man kann aber nicht verlässlich zwischen Kolonisation und Infektion unterscheiden, und die Diagnose lässt sich erst durch invasive Maßnahmen mit höherer Gewissheit stellen. Ob bei der Verwendung nichtbronchoskopischer Techniken vergleichbare Ergebnisse erzielt werden,hängt u. a. von der Lokalisation der Pneumonie ab. Unabhängig von der Technik muss eine vorherige Antibiotikatherapie bei der Interpretation der Ergebnisse berücksichtigt werden. Durch adäquate Initialtherapie lässt sich die Letalität von Pneumonien deutlich reduzieren. Da die kalkulierte Therapie aber noch vor dem definitiven mikrobiologischen Nachweis beginnt, ist es entscheidend, die häufigsten Erreger und ihre Resistenzspektren zu kennen. Mehrere Fachgesellschaften empfehlen, zur Initialtherapie folgende Kriterien zu berücksichtigen: Schwere der Erkrankung,patientenbezogene Risikofaktoren sowie Beginn der Pneumonie, bezogen auf den Zeitpunkt der Aufnahme in das Krankenhaus. Speziell bei Pneumonien, die nach mehreren Tagen auftreten, kann sich das Erregerspektrum zwischen einzelnen Intensivstationen stark unterscheiden. Im Sinne einer Deeskalationstherapie kann es bis zum mikrobiologischen Nachweis erforderlich sein, die Initialtherapie auch auf multiresistente Erreger auszurichten, beispielsweise auf MRSA, Acinetobacter spp., Enterobacteriaceae mit Breitspektrumbetalaktamasen oder Legionellen. Eine antivirale oder antimykotische Therapie ist nur in Einzelfällen gerechtfertigt.
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Krueger, W.A., Daschner, F.D. (2003). Beatmungsassoziierte Pneumonien. In: Bardenheuer, H.J., Forst, H., Rossaint, R., Spahn, D.R. (eds) Weiterbildung für Anästhesisten 2003. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18958-6_3
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