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 German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany.
Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Bochum, Germany.
Pneumologie. 2025 Apr 1. doi: 10.1055/a-2541-9872.
Nosocomial pneumonia, encompassing hospital-acquired (HAP) and ventilator-associated pneumonia (VAP), remains a major cause of morbidity and mortality in hospitalized adults. In response to evolving pathogen profiles and emerging resistance patterns, this updated S3 guideline (AWMF Register No. 020-013) provides an evidence-based framework to enhance the diagnosis, risk stratification, and treatment of nosocomial pneumonia.
The guideline update was developed by a multidisciplinary panel representing key German professional societies. A systematic literature review was conducted with subsequent critical appraisal using the GRADE methodology. Structured consensus conferences and external reviews ensured that the recommendations were clinically relevant, methodologically sound, and aligned with current antimicrobial stewardship principles.
For the management of nosocomial pneumonia patients should be divided in those with and without risk factors for multidrug-resistant pathogens and/or . 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. Combination antibiotic therapy is now reserved for patients in septic shock and high risk for multidrug-resistant pathogens, while select patients may be managed with monotherapy (e. g., meropenem). In clinically stabilized patients, antibiotic therapy should be de-escalated and focused, as well as duration shortened to 7-8 days. In critically ill patients, prolonged application of suitable beta-lactam antibiotics should be preferred. Patients on the intensive care unit (ICU) are at risk for invasive pulmonary aspergillosis (IPA). Diagnostics for should be performed with an antigen test from bronchial lavage fluid.
This updated S3 guideline offers a comprehensive, multidisciplinary approach to the management of nosocomial pneumonia in adults. By integrating novel diagnostic modalities and refined therapeutic strategies, it aims to standardize care, improve patient outcomes, and enhance antimicrobial stewardship to curb the emergence of resistant pathogens.
医院获得性肺炎，包括医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP），仍然是住院成人发病和死亡的主要原因。针对不断变化的病原体谱和新出现的耐药模式，本更新的S3指南（德国医学科学院注册编号：020 - 013）提供了一个循证框架，以加强医院获得性肺炎的诊断、风险分层和治疗。
该指南更新由代表德国主要专业学会的多学科小组制定。采用GRADE方法进行了系统的文献综述及随后的严格评价。结构化的共识会议和外部评审确保了这些建议具有临床相关性、方法学合理性，并与当前的抗菌药物管理原则相一致。
对于医院获得性肺炎的管理，患者应分为有无多重耐药病原体和/或……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，支气管镜诊断并不被认为优于非支气管镜采样。联合抗生素治疗现在仅保留用于感染性休克且有多重耐药病原体高风险的患者，而部分患者可采用单药治疗（如美罗培南）。在临床病情稳定的患者中，抗生素治疗应降级并精准化，疗程也应缩短至7 - 8天。在危重症患者中，应优先延长使用合适的β - 内酰胺类抗生素。重症监护病房（ICU）的患者有侵袭性肺曲霉病（IPA）的风险。应使用支气管肺泡灌洗液的抗原检测进行……的诊断。
本更新的S3指南为成人医院获得性肺炎的管理提供了一种全面的多学科方法。通过整合新的诊断方法和优化的治疗策略，旨在规范治疗、改善患者结局，并加强抗菌药物管理以遏制耐药病原体的出现。
