Ambulant erworbene Pneumonie

Was ist neu?

Pathogene Die Bedeutung von Atemwegsviren bei der CAP wird zunehmend beschrieben. Influenza und Rhinoviren stehen aktuell im Fokus, aber auch andere Atemwegsviren werden genannt.

Risikostratifizierung: Zusätzlich zu den etablierten Parametern stellt der Blutglukosespiegel bei Aufnahme einen zusätzlichen Risikofaktor dar.

Antibiotika Der Stellenwert der zusätzlichen Makrolid-Gabe im Rahmen einer Kombination mit einem Betalaktam-Antibiotikum wird zunehmend differenziert. Patienten mit Bakteriämie und/oder ausgeprägter Entzündungsreaktion profitieren besonders. Bei Patienten mit schwerer Pneumonie sollte immer eine Kombinationstherapie durchgeführt werden. Omadacycline und Solithromycin stellen neue interessante Antibiotika mit erweitertem Spektrum dar.

Abstract

Important new developments in the understanding of CAP encompass new insights into pathogens, risk stratification and antibiotic treatment. Respiratory viruses are increasingly described as relevant pathogens in CAP, such as influenza and rhinoviruses. Risk stratification is central in the management of CAP. In addition to the classical scores blood glucose levels add to the risk prediction. Risk adapted antibiotic treatment is increasingly refined and the use of macrolides in patients with bacteremia or marked inflammation is advocated. Recently developed new antibiotics add to the therapeutic options in CAP.

Schlüsselwörter

Pathogene - Atemwegsviren - Management - Antibiotika - Risikostratifizierung

Key words

pathogens - respiratory viruses - management - antibiotics - risk stratification

• Literatur

• 1 Ewig S, Hoffken G, Kern WV. et al. Management of Adult Community-acquired Pneumonia and Prevention – Update 2016. Pneumologie 2016; 70: 151-200 . doi:10.1055/s-0042-101873
• 2 Kolditz M, Ewig S. Community-Acquired Pneumonia in Adults. Deutsches Aerzteblatt Online 2017; DOI: 10.3238/arztebl.2017.0838.
• 3 Del Rio-Pertuz G, Gutierrez JF, Triana AJ. et al. Usefulness of sputum gram stain for etiologic diagnosis in community-acquired pneumonia: a systematic review and meta-analysis. BMC Infect Dis 2019; 19: 403 . doi:10.1186/s12879-019-4048-6
• 4 Ruuskanen O, Lahti E, Jennings LC. et al. Viral pneumonia. Lancet 2011; 377: 1264-1275 . doi:10.1016/s0140-6736(10)61459-6
• 5 Jain S, Williams DJ, Arnold SR. et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med 2015; 372: 835-845 . doi:10.1056/NEJMoa1405870
• 6 Leven M, Coenen S, Loens K. et al. Aetiology of lower respiratory tract infection in adults in primary care: a prospective study in 11 European countries. Clin Microbiol Infect 2018; 24: 1158-1163 . doi:10.1016/j.cmi.2018.02.004
• 7 Jain S, Self WH, Wunderink RG. et al. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med 2015; 373: 415-427 . doi:10.1056/NEJMoa1500245
• 8 Alimi Y, Lim WS, Lansbury L. et al. Systematic review of respiratory viral pathogens identified in adults with community-acquired pneumonia in Europe. J Clin Virol 2017; 95: 26-35 . doi:10.1016/j.jcv.2017.07.019
• 9 Lim WS, van der Eerden MM, Laing R. et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-382
• 10 Bauer TT, Ewig S, Marre R. et al. CRB-65 predicts death from community-acquired pneumonia. J Intern Med 2006; 260: 93-101
• 11 Lepper PM, Ott S, Nüesch E. et al. Serum glucose levels for predicting death in patients admitted to hospital for community acquired pneumonia: prospective cohort study. BMJ 2012; 344: e3397
• 12 Jensen AV, Egelund GB, Andersen SB. et al. The impact of blood glucose on community-acquired pneumonia: a retrospective cohort study. ERJ Open Res 2017; DOI: 10.1183/23120541.00114-2016.
• 13 Egelund GB, Jensen AV, Andersen SB. et al. Penicillin treatment for patients with Community-Acquired Pneumonia in Denmark: a retrospective cohort study. BMC Pulm Med 2017; 17: 66 . doi:10.1186/s12890-017-0404-8
• 14 Garin N, Genne D, Carballo S. et al. beta-Lactam monotherapy vs beta-lactam-macrolide combination treatment in moderately severe community-acquired pneumonia: a randomized noninferiority trial. JAMA internal medicine 2014; 174: 1894-1901 . doi:10.1001/jamainternmed.2014.4887
• 15 Arnold FW, Lopardo G, Wiemken TL. et al. Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia. Respir Med 2018; 140: 115-121 . doi:10.1016/j.rmed.2018.05.020
• 16 Ceccato A, Cilloniz C, Martin-Loeches I. et al. Effect of Combined beta-Lactam/Macrolide Therapy on Mortality According to the Microbial Etiology and Inflammatory Status of Patients With Community-Acquired Pneumonia. Chest 2019; 155: 795-804 . doi:10.1016/j.chest.2018.11.006
• 17 Stets R, Popescu M, Gonong JR. et al. Omadacycline for Community-Acquired Bacterial Pneumonia. N Engl J Med 2019; 380: 517-527 . doi:10.1056/NEJMoa1800201
• 18 Barrera CM, Mykietiuk A, Metev H. et al. Efficacy and safety of oral solithromycin versus oral moxifloxacin for treatment of community-acquired bacterial pneumonia: a global, double-blind, multicentre, randomised, active-controlled, non-inferiority trial (SOLITAIRE-ORAL). Lancet Infect Dis 2016; 16: 421-430 . doi:10.1016/s1473-3099(16)00017-7