Welte T
Abteilung Pneumologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover.
Intensivmed Notfallmed. 2006;43(4):301-309. doi: 10.1007/s00390-006-0721-2.
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).
医院获得性肺炎是重症监护病房中最常见的感染之一，具有高发病率和死亡率。治疗失败的决定性因素是先前抗生素治疗不足。广谱且剂量足够高的初始治疗至关重要。为防止进一步产生耐药性，必须尽早评估抗生素治疗。根据治疗效果，必须更改或终止治疗。三天后进行降阶梯治疗是可行且合理的。治疗期通常不应超过七天。治疗建议应根据当地的耐药情况和常见病原体的当地统计数据进行调整。治疗决策的另一个因素是患者的风险分析（先前的治疗、住院或养老院停留情况、伴随疾病）。
