Skip to main content
Erschienen in: Die Anaesthesiologie 3/2011

01.03.2011 | CME Weiterbildung · Zertifizierte Fortbildung

Antibiotikatherapie der nosokomialen Pneumonie

verfasst von: S. Weiterer, D. Störzinger, M. Bernhard, K. Mayer, C. Lass-Flörl, M.A. Weigand, Dr. C. Lichtenstern

Erschienen in: Die Anaesthesiologie | Ausgabe 3/2011

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die nosokomiale Pneumonie ist die häufigste auf Intensivstationen und nach der Harnwegsinfektion die zweithäufigste im Krankenhaus erworbene Infektionserkrankung, die nicht selten durch schwer therapierbare Erreger hervorgerufen wird. Bei der Behandlung einer nosokomialen Pneumonie steht die frühe adäquate Therapie mit einem Breitspektrumantibiotikum im Vordergrund. Dabei sind genaue Kenntnisse zum lokalspezifischen Erregerspektrum für die Auswahl der empirisch kalkulierten antiinfektiven Therapie von entscheidener Bedeutung. Im Rahmen einer kritischen Reevaluation der primären Behandlung sind eine keimspezifische Deeskalation der Therapie, die Diagnose pulmonaler Komplikationen (z. B. Pleuraempyem) und die Identifikation sowie entsprechende Sanierung möglicher nichtpulmonaler Infektionsfokusse unverzichtbar. Um einen bestmöglichen Behandlungserfolg zu erreichen, muss das jeweilige Therapiekonzept an individuellen Risikomerkmalen orientiert sein. Frühere Antibiotikagaben, Beatmungsdauer und die Komorbidität des Patienten müssen berücksichtigt werden. Dieses Vorgehen hilft, die Entwicklung von Resistenzen zu vermeiden und wirtschaftliche Resourcen zu schonen.
Literatur
1.
Zurück zum Zitat Alvarez-Lerma F, Alvarez B, Luque P et al (2006) Empiric broad-spectrum antibiotic therapy of nosocomial pneumonia in the intensive care unit: a prospective observational study. Crit Care 10:R78PubMedCrossRef Alvarez-Lerma F, Alvarez B, Luque P et al (2006) Empiric broad-spectrum antibiotic therapy of nosocomial pneumonia in the intensive care unit: a prospective observational study. Crit Care 10:R78PubMedCrossRef
2.
Zurück zum Zitat American Thoracic Society (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416CrossRef American Thoracic Society (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416CrossRef
3.
Zurück zum Zitat American Thoracic Society (1996) Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, November 1995. Am J Respir Crit Care Med 153:1711–1725 American Thoracic Society (1996) Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, November 1995. Am J Respir Crit Care Med 153:1711–1725
4.
Zurück zum Zitat Azoulay E, Timsit JF, Tafflet M et al (2006) Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. Chest 129:110–117PubMedCrossRef Azoulay E, Timsit JF, Tafflet M et al (2006) Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. Chest 129:110–117PubMedCrossRef
5.
Zurück zum Zitat Bodmann KF, Grabein B und die Expertenkommission der Paul-Ehrlich-Gesellschaft fur Chemotherapie e.V. (2010) Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen – Update 2010. http://www.p-e-g.org/econtext/leitlinien Bodmann KF, Grabein B und die Expertenkommission der Paul-Ehrlich-Gesellschaft fur Chemotherapie e.V. (2010) Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen – Update 2010. http://​www.​p-e-g.​org/​econtext/​leitlinien
6.
Zurück zum Zitat Bouadma L, Luyt CE, Tubach F et al (2010) Use of procalcitonin to reduce patients‘ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 375:463–474PubMedCrossRef Bouadma L, Luyt CE, Tubach F et al (2010) Use of procalcitonin to reduce patients‘ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 375:463–474PubMedCrossRef
7.
Zurück zum Zitat Breier A, Sohr D, Geffers C et al (2009) Erreger nosokomialer Infektionen auf Intensivstation. Intensivmedizin 46:220–227CrossRef Breier A, Sohr D, Geffers C et al (2009) Erreger nosokomialer Infektionen auf Intensivstation. Intensivmedizin 46:220–227CrossRef
8.
Zurück zum Zitat Burgmann H, Hiesmayr JM, Savey A et al (2010) Impact of nosocomial infections on clinical outcome and resource consumption in critically ill patients. Intensive Care Med 36:1597–1601PubMedCrossRef Burgmann H, Hiesmayr JM, Savey A et al (2010) Impact of nosocomial infections on clinical outcome and resource consumption in critically ill patients. Intensive Care Med 36:1597–1601PubMedCrossRef
9.
Zurück zum Zitat Chastre J, Wolff M, Fagon JY et al (2003) Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 290:2588–2598PubMedCrossRef Chastre J, Wolff M, Fagon JY et al (2003) Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 290:2588–2598PubMedCrossRef
10.
Zurück zum Zitat Conte JE Jr, Golden JA, Kipps J et al (2002) Intrapulmonary pharmacokinetics of linezolid. Antimicrob Agents Chemother 46:1475–1480PubMedCrossRef Conte JE Jr, Golden JA, Kipps J et al (2002) Intrapulmonary pharmacokinetics of linezolid. Antimicrob Agents Chemother 46:1475–1480PubMedCrossRef
11.
Zurück zum Zitat Cosgrove SE, Vigliani GA, Fowler VG Jr et al (2009) Initial low-dose gentamicin for Staphylococcus aureus bacteremia and endocarditis is nephrotoxic. Clin Infect Dis 48:713–721PubMedCrossRef Cosgrove SE, Vigliani GA, Fowler VG Jr et al (2009) Initial low-dose gentamicin for Staphylococcus aureus bacteremia and endocarditis is nephrotoxic. Clin Infect Dis 48:713–721PubMedCrossRef
12.
Zurück zum Zitat Craig WA (2003) Basic pharmacodynamics of antibacterials with clinical applications to the use of beta-lactams, glycopeptides, and linezolid. Infect Dis Clin North Am 17:479–501PubMedCrossRef Craig WA (2003) Basic pharmacodynamics of antibacterials with clinical applications to the use of beta-lactams, glycopeptides, and linezolid. Infect Dis Clin North Am 17:479–501PubMedCrossRef
13.
14.
Zurück zum Zitat Dennesen PJ, Ven AJ van der, Kessels AG et al (2001) Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med 163:1371–1375PubMed Dennesen PJ, Ven AJ van der, Kessels AG et al (2001) Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med 163:1371–1375PubMed
15.
Zurück zum Zitat Food and Drug Administration (2010) FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections. http://www.fda.gov/Drugs/DrugSafety/ucm224370.htm Food and Drug Administration (2010) FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections. http://​www.​fda.​gov/​Drugs/​DrugSafety/​ucm224370.​htm
16.
Zurück zum Zitat File TM Jr, Low DE, Eckburg PB et al (2010) Integrated analysis of FOCUS 1 and FOCUS 2: randomized, double-blinded, multicenter phase 3 trials of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in patients with community-acquired pneumonia. Clin Infect Dis 51:1395–1405PubMedCrossRef File TM Jr, Low DE, Eckburg PB et al (2010) Integrated analysis of FOCUS 1 and FOCUS 2: randomized, double-blinded, multicenter phase 3 trials of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in patients with community-acquired pneumonia. Clin Infect Dis 51:1395–1405PubMedCrossRef
17.
Zurück zum Zitat Garcin F, Leone M, Antonini F et al (2010) Non-adherence to guidelines: an avoidable cause of failure of empirical antimicrobial therapy in the presence of difficult-to-treat bacteria. Intensive Care Med 36:75–82PubMedCrossRef Garcin F, Leone M, Antonini F et al (2010) Non-adherence to guidelines: an avoidable cause of failure of empirical antimicrobial therapy in the presence of difficult-to-treat bacteria. Intensive Care Med 36:75–82PubMedCrossRef
18.
Zurück zum Zitat Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A et al (2003) Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 31:2742–2751PubMedCrossRef Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A et al (2003) Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 31:2742–2751PubMedCrossRef
19.
Zurück zum Zitat Gastmeier P, Sohr D, Geffers C et al (2009) Early- and late-onset pneumonia: is this still a useful classification? Antimicrob Agents Chemother 53:2714–2718PubMedCrossRef Gastmeier P, Sohr D, Geffers C et al (2009) Early- and late-onset pneumonia: is this still a useful classification? Antimicrob Agents Chemother 53:2714–2718PubMedCrossRef
20.
Zurück zum Zitat Giamarellos-Bourboulis EJ, Pechere JC, Routsi C et al (2008) Effect of clarithromycin in patients with sepsis and ventilator-associated pneumonia. Clin Infect Dis 46:1157–1164PubMedCrossRef Giamarellos-Bourboulis EJ, Pechere JC, Routsi C et al (2008) Effect of clarithromycin in patients with sepsis and ventilator-associated pneumonia. Clin Infect Dis 46:1157–1164PubMedCrossRef
21.
Zurück zum Zitat Heyland DK, Dodek P, Muscedere J et al (2008) Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia. Crit Care Med 36:737–744PubMedCrossRef Heyland DK, Dodek P, Muscedere J et al (2008) Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia. Crit Care Med 36:737–744PubMedCrossRef
22.
Zurück zum Zitat Hoffman LR, D’Argenio DA, MacCoss MJ et al (2005) Aminoglycoside antibiotics induce bacterial biofilm formation. Nature 436:1171–1175PubMedCrossRef Hoffman LR, D’Argenio DA, MacCoss MJ et al (2005) Aminoglycoside antibiotics induce bacterial biofilm formation. Nature 436:1171–1175PubMedCrossRef
23.
Zurück zum Zitat Ibrahim EH, Ward S, Sherman G et al (2001) Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 29:1109–1115PubMedCrossRef Ibrahim EH, Ward S, Sherman G et al (2001) Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 29:1109–1115PubMedCrossRef
24.
Zurück zum Zitat Itani KM, Weigelt J, Li JZ et al (2005) Linezolid reduces length of stay and duration of intravenous treatment compared with vancomycin for complicated skin and soft tissue infections due to suspected or proven methicillin-resistant Staphylococcus aureus (MRSA). Int J Antimicrob Agents 26:442–448PubMedCrossRef Itani KM, Weigelt J, Li JZ et al (2005) Linezolid reduces length of stay and duration of intravenous treatment compared with vancomycin for complicated skin and soft tissue infections due to suspected or proven methicillin-resistant Staphylococcus aureus (MRSA). Int J Antimicrob Agents 26:442–448PubMedCrossRef
25.
Zurück zum Zitat Jung B, Embriaco N, Roux F et al (2010) Microbiological data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score. Intensive Care Med 36:790–798PubMedCrossRef Jung B, Embriaco N, Roux F et al (2010) Microbiological data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score. Intensive Care Med 36:790–798PubMedCrossRef
26.
Zurück zum Zitat Kalil AC, Murthy MH, Hermsen ED et al (2010) Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. Crit Care Med 38:1802–1808PubMedCrossRef Kalil AC, Murthy MH, Hermsen ED et al (2010) Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. Crit Care Med 38:1802–1808PubMedCrossRef
27.
Zurück zum Zitat Kohlenberg A, Schwab F, Behnke M et al (2010) Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Med 36:971–978PubMedCrossRef Kohlenberg A, Schwab F, Behnke M et al (2010) Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Med 36:971–978PubMedCrossRef
28.
Zurück zum Zitat Kohler T, Perron GG, Buckling A et al (2010) Quorum sensing inhibition selects for virulence and cooperation in Pseudomonas aeruginosa. PLoS Pathog 6:e1000883PubMedCrossRef Kohler T, Perron GG, Buckling A et al (2010) Quorum sensing inhibition selects for virulence and cooperation in Pseudomonas aeruginosa. PLoS Pathog 6:e1000883PubMedCrossRef
29.
Zurück zum Zitat Kollef MH (2000) Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 31(Suppl 4):131–138CrossRef Kollef MH (2000) Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 31(Suppl 4):131–138CrossRef
30.
Zurück zum Zitat Kopterides P, Siempos II, Tsangaris I et al (2010) Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med 38:2229–2241PubMedCrossRef Kopterides P, Siempos II, Tsangaris I et al (2010) Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med 38:2229–2241PubMedCrossRef
31.
Zurück zum Zitat Kruger S, Ewig S, Marre R et al (2008) Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 31:349–355PubMedCrossRef Kruger S, Ewig S, Marre R et al (2008) Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 31:349–355PubMedCrossRef
32.
Zurück zum Zitat Kumar A, Ellis P, Arabi Y et al (2009) Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 136:1237–1248PubMedCrossRef Kumar A, Ellis P, Arabi Y et al (2009) Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 136:1237–1248PubMedCrossRef
33.
Zurück zum Zitat Kumar A, Safdar N, Kethireddy S et al (2010) A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic/meta-regression study. Crit Care Med 38:1651–1664PubMedCrossRef Kumar A, Safdar N, Kethireddy S et al (2010) A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic/meta-regression study. Crit Care Med 38:1651–1664PubMedCrossRef
34.
Zurück zum Zitat Leone M, Bourgoin A, Cambon S et al (2003) Empirical antimicrobial therapy of septic shock patients: adequacy and impact on the outcome. Crit Care Med 31:462–467PubMedCrossRef Leone M, Bourgoin A, Cambon S et al (2003) Empirical antimicrobial therapy of septic shock patients: adequacy and impact on the outcome. Crit Care Med 31:462–467PubMedCrossRef
35.
Zurück zum Zitat Lodise TP Jr, Lomaestro B, Drusano GL (2007) Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy. Clin Infect Dis 44:357–363PubMedCrossRef Lodise TP Jr, Lomaestro B, Drusano GL (2007) Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy. Clin Infect Dis 44:357–363PubMedCrossRef
36.
Zurück zum Zitat Lorenz J, Bodmann KF, Bauer TT et al (2003) Nosocomial pneumonia: prevention, diagnosis, treatment. Pneumologie 57:532–545PubMedCrossRef Lorenz J, Bodmann KF, Bauer TT et al (2003) Nosocomial pneumonia: prevention, diagnosis, treatment. Pneumologie 57:532–545PubMedCrossRef
37.
Zurück zum Zitat Lu Q, Girardi C, Zhang M et al (2010) Nebulized and intravenous colistin in experimental pneumonia caused by Pseudomonas aeruginosa. Intensive Care Med 36:1147–1155PubMedCrossRef Lu Q, Girardi C, Zhang M et al (2010) Nebulized and intravenous colistin in experimental pneumonia caused by Pseudomonas aeruginosa. Intensive Care Med 36:1147–1155PubMedCrossRef
38.
Zurück zum Zitat Luyt CE, Combes A, Nieszkowska A et al (2009) Aerosolized antibiotics to treat ventilator-associated pneumonia. Curr Opin Infect Dis 22:154–158PubMedCrossRef Luyt CE, Combes A, Nieszkowska A et al (2009) Aerosolized antibiotics to treat ventilator-associated pneumonia. Curr Opin Infect Dis 22:154–158PubMedCrossRef
39.
Zurück zum Zitat Luyt CE, Guerin V, Combes A et al (2005) Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 171:48–53PubMedCrossRef Luyt CE, Guerin V, Combes A et al (2005) Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 171:48–53PubMedCrossRef
40.
Zurück zum Zitat Melsen WG, Rovers MM, Bonten MJ (2009) Ventilator-associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med 37:2709–2718PubMedCrossRef Melsen WG, Rovers MM, Bonten MJ (2009) Ventilator-associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med 37:2709–2718PubMedCrossRef
41.
Zurück zum Zitat Meyer E, Sohr D, Gastmeier P et al (2009) New identification of outliers and ventilator-associated pneumonia rates from 2005 to 2007 within the German Nosocomial Infection Surveillance System. J Hosp Infect 73:246–252PubMedCrossRef Meyer E, Sohr D, Gastmeier P et al (2009) New identification of outliers and ventilator-associated pneumonia rates from 2005 to 2007 within the German Nosocomial Infection Surveillance System. J Hosp Infect 73:246–252PubMedCrossRef
42.
Zurück zum Zitat Nguile-Makao M, Zahar JR, Francais A et al (2010) Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med 36:781–789PubMedCrossRef Nguile-Makao M, Zahar JR, Francais A et al (2010) Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med 36:781–789PubMedCrossRef
43.
Zurück zum Zitat Nicolau DP (2003) Optimizing outcomes with antimicrobial therapy through pharmacodynamic profiling. J Infect Chemother 9:292–296PubMedCrossRef Nicolau DP (2003) Optimizing outcomes with antimicrobial therapy through pharmacodynamic profiling. J Infect Chemother 9:292–296PubMedCrossRef
44.
Zurück zum Zitat Nobre V, Harbarth S, Graf JD et al (2008) Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 177:498–505PubMedCrossRef Nobre V, Harbarth S, Graf JD et al (2008) Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 177:498–505PubMedCrossRef
45.
Zurück zum Zitat Paul M, Benuri-Silbiger I, Soares-Weiser K et al (2004) Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials. BMJ 328:668PubMedCrossRef Paul M, Benuri-Silbiger I, Soares-Weiser K et al (2004) Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials. BMJ 328:668PubMedCrossRef
46.
Zurück zum Zitat Peleg AY, Hooper DC (2010) Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 362:1804–1813PubMedCrossRef Peleg AY, Hooper DC (2010) Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 362:1804–1813PubMedCrossRef
47.
Zurück zum Zitat Reinhart K, Brunkhorst FM, Bone HG et al (2010) Prevention, diagnosis, treatment, and follow-up care of sepsis. First revision of the S2 k Guidelines of the German Sepsis Society (DSG) and the German Interdisciplinary Association for Intensive and Emergency Care Medicine (DIVI). Anaesthesist 59:347–370PubMedCrossRef Reinhart K, Brunkhorst FM, Bone HG et al (2010) Prevention, diagnosis, treatment, and follow-up care of sepsis. First revision of the S2 k Guidelines of the German Sepsis Society (DSG) and the German Interdisciplinary Association for Intensive and Emergency Care Medicine (DIVI). Anaesthesist 59:347–370PubMedCrossRef
48.
Zurück zum Zitat Roberts JA, Lipman J (2009) Pharmacokinetic issues for antibiotics in the critically ill patient. Crit Care Med 37:840–851; quiz 859PubMedCrossRef Roberts JA, Lipman J (2009) Pharmacokinetic issues for antibiotics in the critically ill patient. Crit Care Med 37:840–851; quiz 859PubMedCrossRef
49.
Zurück zum Zitat Roberts JA, Roberts MS, Robertson TA et al (2009) Piperacillin penetration into tissue of critically ill patients with sepsis-bolus versus continuous administration? Crit Care Med 37:926–933PubMedCrossRef Roberts JA, Roberts MS, Robertson TA et al (2009) Piperacillin penetration into tissue of critically ill patients with sepsis-bolus versus continuous administration? Crit Care Med 37:926–933PubMedCrossRef
50.
Zurück zum Zitat Roberts JA, Webb S, Paterson D et al (2009) A systematic review on clinical benefits of continuous administration of beta-lactam antibiotics. Crit Care Med 37:2071–2078PubMedCrossRef Roberts JA, Webb S, Paterson D et al (2009) A systematic review on clinical benefits of continuous administration of beta-lactam antibiotics. Crit Care Med 37:2071–2078PubMedCrossRef
51.
Zurück zum Zitat Rodriguez A, Rello J (2007) Mono versus combination antibiotic therapy: Who is right? Crit Care Med 35:2668PubMedCrossRef Rodriguez A, Rello J (2007) Mono versus combination antibiotic therapy: Who is right? Crit Care Med 35:2668PubMedCrossRef
52.
Zurück zum Zitat Rubinstein E, Lalani T, Corey GR et al (2011) Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens. Clin Infect Dis 52:31–40PubMedCrossRef Rubinstein E, Lalani T, Corey GR et al (2011) Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens. Clin Infect Dis 52:31–40PubMedCrossRef
53.
Zurück zum Zitat Safdar N, Handelsman J, Maki DG (2004) Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis 4:519–527PubMedCrossRef Safdar N, Handelsman J, Maki DG (2004) Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis 4:519–527PubMedCrossRef
54.
Zurück zum Zitat Sandiumenge A, Diaz E, Bodi M et al (2003) Therapy of ventilator-associated pneumonia. A patient-based approach based on the ten rules of „The Tarragona Strategy“. Intensive Care Med 29:876–883PubMed Sandiumenge A, Diaz E, Bodi M et al (2003) Therapy of ventilator-associated pneumonia. A patient-based approach based on the ten rules of „The Tarragona Strategy“. Intensive Care Med 29:876–883PubMed
55.
Zurück zum Zitat Stolz D, Smyrnios N, Eggimann P et al (2009) Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study. Eur Respir J 34:1364–1375PubMedCrossRef Stolz D, Smyrnios N, Eggimann P et al (2009) Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study. Eur Respir J 34:1364–1375PubMedCrossRef
56.
Zurück zum Zitat Taccone FS, Laterre PF, Dugernier T et al (2010) Insufficient beta-lactam concentrations in the early phase of severe sepsis and septic shock. Crit Care 14:R126PubMedCrossRef Taccone FS, Laterre PF, Dugernier T et al (2010) Insufficient beta-lactam concentrations in the early phase of severe sepsis and septic shock. Crit Care 14:R126PubMedCrossRef
57.
Zurück zum Zitat Trouillet JL, Chastre J, Vuagnat A et al (1998) Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 157:531–539PubMed Trouillet JL, Chastre J, Vuagnat A et al (1998) Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 157:531–539PubMed
58.
Zurück zum Zitat Vidaur L, Gualis B, Rodriguez A et al (2005) Clinical resolution in patients with suspicion of ventilator-associated pneumonia: a cohort study comparing patients with and without acute respiratory distress syndrome. Crit Care Med 33:1248–1253PubMedCrossRef Vidaur L, Gualis B, Rodriguez A et al (2005) Clinical resolution in patients with suspicion of ventilator-associated pneumonia: a cohort study comparing patients with and without acute respiratory distress syndrome. Crit Care Med 33:1248–1253PubMedCrossRef
59.
Zurück zum Zitat Vincent JL, Rello J, Marshall J et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302:2323–2329PubMedCrossRef Vincent JL, Rello J, Marshall J et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302:2323–2329PubMedCrossRef
60.
Zurück zum Zitat Welte T (2009) Community-acquired pneumonia. Internist (Berl) 50:331–339; quiz 340 Welte T (2009) Community-acquired pneumonia. Internist (Berl) 50:331–339; quiz 340
61.
Zurück zum Zitat Wunderink RG, Rello J, Cammarata SK et al (2003) Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Chest 124:1789–1797PubMedCrossRef Wunderink RG, Rello J, Cammarata SK et al (2003) Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Chest 124:1789–1797PubMedCrossRef
Metadaten
Titel
Antibiotikatherapie der nosokomialen Pneumonie
verfasst von
S. Weiterer
D. Störzinger
M. Bernhard
K. Mayer
C. Lass-Flörl
M.A. Weigand
Dr. C. Lichtenstern
Publikationsdatum
01.03.2011
Verlag
Springer-Verlag
Erschienen in
Die Anaesthesiologie / Ausgabe 3/2011
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-011-1861-8

Weitere Artikel der Ausgabe 3/2011

Die Anaesthesiologie 3/2011 Zur Ausgabe

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.