Rademacher Jessica, Ewig Santiago, Grabein Béatrice, Nachtigall Irit, Abele-Horn Marianne, Deja Maria, Gaßner Martina, Gatermann Sören, Geffers Christine, Gerlach Herwig, Hagel Stefan, Heußel Claus Peter, Kluge Stefan, Kolditz Martin, Kramme Evelyn, Kühl Hilmar, Panning Marcus, Rath Peter-Michael, Rohde Gernot, Schaaf Bernhard, Salzer Helmut J F, Schreiter Dierk, Schweisfurth Hans, Unverzagt Susanne, Weigand Markus A, Welte Tobias, Pletz Mathias W
Department of Respiratory Medicine and Infectious Diseases, German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany.
Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, EVK Herne and Augusta-Kranken-Anstalt Bochum, Bochum, Germany.
Infection. 2024 Dec;52(6):2531-2545. doi: 10.1007/s15010-024-02358-y. Epub 2024 Aug 8.
This executive summary of a German national guideline aims to provide the most relevant evidence-based recommendations on the diagnosis and treatment of nosocomial pneumonia.
The guideline made use of a systematic assessment and decision process using evidence to decision framework (GRADE). Recommendations were consented by an interdisciplinary panel. Evidence analysis and interpretation was supported by the German innovation fund providing extensive literature searches and (meta-) analyses by an independent methodologist. For this executive summary, selected key recommendations are presented including the quality of evidence and rationale for the level of recommendation.
The original guideline contains 26 recommendations for the diagnosis and treatment of adults with nosocomial pneumonia, thirteen of which are based on systematic review and/or meta-analysis, while the other 13 represent consensus expert opinion. For this key summary, we present 11 most relevant for everyday clinical practice key recommendations with evidence overview and rationale, of which two are expert consensus and 9 evidence-based (4 strong, 5 weak and 2 open recommendations). For the management of nosocomial pneumonia patients should be divided in those with and without risk factors for multidrug-resistant pathogens and/or Pseudomonas aeruginosa. Bacterial multiplex-polymerase chain reaction (PCR) should not be used routinely. Bronchoscopic diagnosis is not considered superior to´non-bronchoscopic sampling in terms of main outcomes. Only patients with septic shock and the presence of an additional risk factor for multidrug-resistant pathogens (MDRP) should receive empiric combination therapy. In clinically stabilized patients, antibiotic therapy should be de-escalated and focused. In critically ill patients, prolonged application of suitable beta-lactam antibiotics should be preferred. Therapy duration is suggested for 7-8 days. Procalcitonin (PCT) based algorithm might be used to shorten the duration of antibiotic treatment. Patients on the intensive care unit (ICU) are at risk for invasive pulmonary aspergillosis (IPA). Diagnostics for Aspergillus should be performed with an antigen test from bronchial lavage fluid.
The current guideline focuses on German epidemiology and standards of care. It should be a guide for the current treatment and management of nosocomial pneumonia in Germany.
本德国国家指南的执行摘要旨在提供关于医院获得性肺炎诊断和治疗的最相关循证建议。
该指南采用基于证据到决策框架（GRADE）的系统评估和决策过程。建议由一个跨学科小组达成共识。德国创新基金通过独立方法学家进行广泛的文献检索和（荟萃）分析，为证据分析和解读提供支持。对于本执行摘要，列出了选定的关键建议，包括证据质量和推荐等级的理由。
原始指南包含26条关于成人医院获得性肺炎诊断和治疗的建议，其中13条基于系统评价和/或荟萃分析，另外13条代表专家共识意见。对于本关键摘要，我们列出了11条对日常临床实践最相关的关键建议，并附有证据概述和理由，其中2条为专家共识，9条基于证据（4条强推荐、5条弱推荐和2条开放性推荐）。对于医院获得性肺炎的管理，患者应分为有和没有多重耐药病原体和/或铜绿假单胞菌危险因素的两类。细菌多重聚合酶链反应（PCR）不应常规使用。就主要结局而言，支气管镜诊断并不优于非支气管镜采样。只有患有感染性休克且存在多重耐药病原体（MDRP）额外危险因素的患者才应接受经验性联合治疗。在临床病情稳定的患者中，抗生素治疗应降阶梯并精准用药。在危重症患者中，应优先选择延长合适的β-内酰胺类抗生素的使用时间。建议治疗疗程为7 - 8天。基于降钙素原（PCT）的算法可用于缩短抗生素治疗时间。重症监护病房（ICU）的患者有侵袭性肺曲霉病（IPA）的风险。应通过支气管肺泡灌洗液的抗原检测进行曲霉诊断。
当前指南聚焦于德国的流行病学和护理标准。它应成为德国目前医院获得性肺炎治疗和管理的指南。
