Ewig Santiago
Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Krankenhaus Bochum, Hordeler Straße 7-9, 44651, Herne, Deutschland.
Anaesthesiologie. 2024 Sep;73(9):630-644. doi: 10.1007/s00101-024-01451-z.
Nosocomial pneumonia is defined as pneumonia occurring ≥ 48 h after hospital admission in a patient without severe immunosuppression. It can occur in spontaneously breathing patients or with noninvasive ventilation (NIV) and mechanically ventilated patients. In patients with suspected ventilator-associated pneumonia (VAP) (semi)quantitative cultures of tracheobronchial aspirates or bronchoalveolar lavage fluid should be perfomed. The initial empirical antimicrobial treatment is determined by the risk for multidrug-resistant pathogens (MDRP). The advantage of combination treatment increases with the prevalence of MDRPs. The antibiotic treatment should be adapted when the microbiological results are available. After 72 h a standardized re-evaluation including the response to treatment and also checking of the suspected diagnosis of pneumonia in a structured form is mandatory. Treatment failure can occur as a primary or secondary failure and in the case of primary progression necessitates another comprehensive diagnostic work-up before any further antibiotic treatment.
医院获得性肺炎定义为在无严重免疫抑制的患者入院≥48小时后发生的肺炎。它可发生于自主呼吸患者、接受无创通气（NIV）的患者以及机械通气患者。对于疑似呼吸机相关性肺炎（VAP）的患者，应进行气管支气管吸出物或支气管肺泡灌洗 fluid 的（半）定量培养。初始经验性抗菌治疗取决于多重耐药病原体（MDRP）的风险。联合治疗的优势随着MDRP的流行率增加而增加。当微生物学结果可用时，应调整抗生素治疗。72小时后，必须进行标准化的重新评估，包括对治疗的反应，并以结构化形式检查疑似肺炎诊断。治疗失败可表现为原发性或继发性失败，对于原发性进展的情况，在进行任何进一步的抗生素治疗之前，需要进行另一次全面的诊断检查。
