[Hospital-acquired pneumonia - new guidelines].
Identifieur interne : 000009 ( Main/Exploration ); précédent : 000008; suivant : 000010[Hospital-acquired pneumonia - new guidelines].
Auteurs : Evelyn Kramme ; Klaus DalhoffSource :
- Deutsche medizinische Wochenschrift (1946) [ 1439-4413 ] ; 2019.
Descripteurs français
- KwdFr :
- Allemagne (MeSH), Anti-infectieux (usage thérapeutique), Guides de bonnes pratiques cliniques comme sujet (MeSH), Humains (MeSH), Multirésistance bactérienne aux médicaments (MeSH), Pneumonie associée aux soins (diagnostic), Pneumonie associée aux soins (microbiologie), Pneumonie associée aux soins (thérapie).
- MESH :
- diagnostic : Pneumonie associée aux soins.
- microbiologie : Pneumonie associée aux soins.
- thérapie : Pneumonie associée aux soins.
- usage thérapeutique : Anti-infectieux.
- Allemagne, Guides de bonnes pratiques cliniques comme sujet, Humains, Multirésistance bactérienne aux médicaments.
- Wicri :
- geographic : Allemagne.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Anti-Infective Agents.
- geographic : Germany.
- diagnosis : Healthcare-Associated Pneumonia.
- microbiology : Healthcare-Associated Pneumonia.
- therapy : Healthcare-Associated Pneumonia.
- Drug Resistance, Multiple, Bacterial, Humans, Practice Guidelines as Topic.
Abstract
ETIOLOGY
The role of multidrug-resistant (MDR) pathogens in nosocomial infections is increasing. However national data in Germany do not show significant changes in the spectrum of pathogens in hospital-acquired pneumonia (HAP). The assessment of individual risk factors for MDR pathogens remains central for the selection of empiric antimicrobial therapy.
DIAGNOSTICS
Thoracic ultrasound may be added as part of the diagnostic work-up and for the detection of complications. Procalcitonin and lactate testing are recommended for the diagnosis of sepsis/septic shock in addition to sepsis scores. Detection of influenza virus by PCR from respiratory samples is recommended during influenza season.
ANTIMICROBIAL TREATMENT
Empiric combination therapy is only recommended for patients with severe HAP (invasive ventilation, septic shock) and high risk of infection with MDR pathogens, since combination therapy has only been shown to be superior in this situation. Deescalation according to clinical and microbiological criteria is highly recommended. In patients with septic organ dysfunction/septic shock antibiotic dosing of adequately choosen betalactams according to Pk/Pd criteria is endorsed.
AEROSOLISED ANTIBIOTICS
adjunctive aerosolised therapy should only be performed in experienced centres. This remains an option for patients with detection of MDR pathogens, who are not deemed successfully treatable with systemic therapy alone.
DOI: 10.1055/a-0652-8351
PubMed: 31163469
Affiliations:
Links toward previous steps (curation, corpus...)
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However national data in Germany do not show significant changes in the spectrum of pathogens in hospital-acquired pneumonia (HAP). The assessment of individual risk factors for MDR pathogens remains central for the selection of empiric antimicrobial therapy.</p></div><div type="abstract" xml:lang="en"><p><b>DIAGNOSTICS</b></p><p>Thoracic ultrasound may be added as part of the diagnostic work-up and for the detection of complications. Procalcitonin and lactate testing are recommended for the diagnosis of sepsis/septic shock in addition to sepsis scores. Detection of influenza virus by PCR from respiratory samples is recommended during influenza season.</p></div><div type="abstract" xml:lang="en"><p><b>ANTIMICROBIAL TREATMENT</b></p><p>Empiric combination therapy is only recommended for patients with severe HAP (invasive ventilation, septic shock) and high risk of infection with MDR pathogens, since combination therapy has only been shown to be superior in this situation. Deescalation according to clinical and microbiological criteria is highly recommended. In patients with septic organ dysfunction/septic shock antibiotic dosing of adequately choosen betalactams according to Pk/Pd criteria is endorsed.</p></div><div type="abstract" xml:lang="en"><p><b>AEROSOLISED ANTIBIOTICS</b></p><p>adjunctive aerosolised therapy should only be performed in experienced centres. This remains an option for patients with detection of MDR pathogens, who are not deemed successfully treatable with systemic therapy alone.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">31163469</PMID><DateCompleted><Year>2019</Year><Month>09</Month><Day>27</Day></DateCompleted><DateRevised><Year>2019</Year><Month>09</Month><Day>27</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1439-4413</ISSN><JournalIssue CitedMedium="Internet"><Volume>144</Volume><Issue>11</Issue><PubDate><Year>2019</Year><Month>06</Month></PubDate></JournalIssue><Title>Deutsche medizinische Wochenschrift (1946)</Title><ISOAbbreviation>Dtsch. Med. Wochenschr.</ISOAbbreviation></Journal><ArticleTitle>[Hospital-acquired pneumonia - new guidelines].</ArticleTitle><Pagination><MedlinePgn>724-728</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1055/a-0652-8351</ELocationID><Abstract><AbstractText Label="ETIOLOGY">The role of multidrug-resistant (MDR) pathogens in nosocomial infections is increasing. However national data in Germany do not show significant changes in the spectrum of pathogens in hospital-acquired pneumonia (HAP). The assessment of individual risk factors for MDR pathogens remains central for the selection of empiric antimicrobial therapy.</AbstractText><AbstractText Label="DIAGNOSTICS">Thoracic ultrasound may be added as part of the diagnostic work-up and for the detection of complications. Procalcitonin and lactate testing are recommended for the diagnosis of sepsis/septic shock in addition to sepsis scores. Detection of influenza virus by PCR from respiratory samples is recommended during influenza season.</AbstractText><AbstractText Label="ANTIMICROBIAL TREATMENT">Empiric combination therapy is only recommended for patients with severe HAP (invasive ventilation, septic shock) and high risk of infection with MDR pathogens, since combination therapy has only been shown to be superior in this situation. Deescalation according to clinical and microbiological criteria is highly recommended. In patients with septic organ dysfunction/septic shock antibiotic dosing of adequately choosen betalactams according to Pk/Pd criteria is endorsed.</AbstractText><AbstractText Label="AEROSOLISED ANTIBIOTICS">adjunctive aerosolised therapy should only be performed in experienced centres. This remains an option for patients with detection of MDR pathogens, who are not deemed successfully treatable with systemic therapy alone.</AbstractText><CopyrightInformation>© Georg Thieme Verlag KG Stuttgart · New York.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kramme</LastName><ForeName>Evelyn</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Klinik für Infektiologie und Mikrobiologie, UKSH Campus Lübeck.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dalhoff</LastName><ForeName>Klaus</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Medizinische Klinik III, UKSH Campus Lübeck.</Affiliation></AffiliationInfo></Author></AuthorList><Language>ger</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><VernacularTitle>Nosokomiale Pneumonie – neue Leitlinien.</VernacularTitle><ArticleDate DateType="Electronic"><Year>2019</Year><Month>06</Month><Day>04</Day></ArticleDate></Article><MedlineJournalInfo><Country>Germany</Country><MedlineTA>Dtsch Med Wochenschr</MedlineTA><NlmUniqueID>0006723</NlmUniqueID><ISSNLinking>0012-0472</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000890">Anti-Infective Agents</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000890" MajorTopicYN="N">Anti-Infective Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D024901" MajorTopicYN="N">Drug Resistance, Multiple, Bacterial</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005858" MajorTopicYN="N" Type="Geographic">Germany</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000077299" MajorTopicYN="Y">Healthcare-Associated Pneumonia</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017410" MajorTopicYN="N">Practice Guidelines as Topic</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="ger"><AbstractText Label="ERREGERSPEKTRUM">DIE ROLLE MULTIRESISTENTER ERREGER: Das nationale Referenzzentrum verzeichnet insgesamt eine Zunahme der Nachweise gramnegativer multiresistenter Erreger (MRE), was sich nach bisheriger Datenlage noch nicht auf das Erregerspektrum der HAP (hospital aquired pneumonia) ausgewirkt hat. Das individuelle Risikoprofil für das Auftreten von MRE bleibt entscheidend für die kalkulierte Therapie.</AbstractText><AbstractText Label="DIAGNOSTIK">Als ergänzende diagnostische Maßnahme wurde die Thoraxsonografie in die Empfehlung aufgenommen. Besondere Bedeutung misst die Leitlinie der Messung von PCT und Laktat bei, um frühzeitig eine Sepsis/einen septischen Schock zu erkennen. Als Empfehlung zur virologischen Diagnostik kam die Durchführung einer PCR in der Influenza-Saison hinzu.</AbstractText><AbstractText Label="KALKULIERTE THERAPIE">INITIAL MONO- ODER KOMBINATIONSTHERAPIE?: Eine Kombinationstherapie wird nur noch bei sehr schwerer Erkrankung (invasive Beatmung, septischer Schock) und hohem Risiko für MRE empfohlen, da sie sich in zahlreichen Studien nur in diesen Konstellationen als überlegen erwiesen hat. Es wird eine deutliche Empfehlung zur zügigen Deeskalation nach klinischen und mikrobiologischen Kriterien ausgesprochen.Aufgrund pharmakokinetischer/pharmakodynamischer Erwägungen sollte bei Patienten mit Sepsis/septischem Schock in der Initialphase eine prolongierte Infusion von hierfür geeigneten Betalaktam-Antibiotika nach initialer Kurzinfusion erwogen werden.</AbstractText><AbstractText Label="INHALATIVE THERAPIE">Eine adjunktive aerosolierte Therapie sollte nur in erfahrenen Zentren bei Nachweis von Erregern mit multiplen Resistenzen durchgeführt werden, wenn der Therapieerfolg einer systemischen Therapie fraglich ist.</AbstractText></OtherAbstract><CoiStatement>Evelyn Kramme gibt an, dass sie Vortragshonorare der Firmen Gilead, Astellas, Pfizer und MSD erhalten hat. Außerdem besuchte sie zwei von Bayer und eine von Gilead gesponserte Fortbildungsveranstaltung(en). Regelmäßig erhält sie Honorare der Deutschen Gesellschaft für Infektiologie im Rahmen ihrer Organisations- und Vortragstätigkeit für Antibiotic-Stewardship-Kurse.Klaus Dalhoff erhielt Vortragshonorare von BayerVital und Gilead.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>6</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>6</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2019</Year><Month>9</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">31163469</ArticleId><ArticleId IdType="doi">10.1055/a-0652-8351</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list></list><tree><noCountry><name sortKey="Dalhoff, Klaus" sort="Dalhoff, Klaus" uniqKey="Dalhoff K" first="Klaus" last="Dalhoff">Klaus Dalhoff</name><name sortKey="Kramme, Evelyn" sort="Kramme, Evelyn" uniqKey="Kramme E" first="Evelyn" last="Kramme">Evelyn Kramme</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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