Nosokomiale und beatmungsassoziierte Pneumonien

Kernaussagen

• Die nosokomiale Pneumonie bleibt eine Erkrankung mit hoher Morbidität und Letalität.

• Die primär adäquate Antibiotikatherapie - frühzeitig, breit und hochdosiert, an der lokalen Erregersituation orientiert - ist der entscheidende Faktor für eine erfolgreiche Therapie.

• Die Risikofaktorenanalyse des Patienten (Vortherapie, Lebensraum, Begleiterkrankungen) fließt in die Therapieüberlegungen ein.

• Grundsätzlich geeignet für eine empirische Initialtherapie sind Piperacillin (+ Inhibitor) und pseudomonaswirksame Cephlosporine sowie Carbapeneme.

• Eine Kombinationstherapie mit Aminoglykosiden oder Fluorchinolonen ist möglich, jedoch nicht durch positive Studien belegt.

• Vancomycin bleibt der Standard für die MRSA Therapie, mit Linezolid steht zumindestens für die schwere Infektion eine Alternative zur Verfügung.

• Die Therapiedauer von sieben Tagen sollte nur in Einzelfällen überschritten werden.

• Supportive Maßnahmen wie ausreichende Volumensubstitution, Thromboseprophylaxe und Sauerstoffgabe entsprechen allgemeinen Therapieprinzipien in der Therapie schwer kranker Patienten.

• Ein Übergang einer nosokomialen Pneumonie in eine schwere Sepsis oder einen septischen Schock ist häufig und erfordert entsprechende therapeutische Maßnahmen.

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