title: [Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy].
abstract: Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However infections on general wards are also increasing. A central issue are infections with multi drug resistant (MDR) pathogens which are difficult to treat particularly in the empirical setting potentially leading to inappropriate use of antimicrobial therapy. This guideline was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and therapy of HAP on the basis of quality of evidence and benefit/risk ratio. The guideline has two parts. First an update on epidemiology, spectrum of pathogens and antiinfectives is provided. In the second part recommendations for the management of diagnosis and treatment are given. Proper microbiologic work up is emphasized for knowledge of the local patterns of microbiology and drug susceptibility. Moreover this is the optimal basis for deescalation in the individual patient. The intensity of antimicrobial therapy is guided by the risk of infections with MDR. Structured deescalation concepts and strict limitation of treatment duration should lead to reduced selection pressure.
authors.affiliation: Medizinische Klinik III, Pneumologie und Infektiologie, Universitätsklinikum Schleswig-Holstein, Lübeck. klaus.dalhoff@uk-sh.de
authors.forename: K
authors.initials: K
authors.lastname: Dalhoff
authors.forename: M
authors.initials: M
authors.lastname: Abele-Horn
authors.forename: S
authors.initials: S
authors.lastname: Andreas
authors.forename: T
authors.initials: T
authors.lastname: Bauer
authors.forename: H
authors.initials: H
authors.lastname: von Baum
authors.forename: M
authors.initials: M
authors.lastname: Deja
authors.forename: S
authors.initials: S
authors.lastname: Ewig
authors.forename: P
authors.initials: P
authors.lastname: Gastmeier
authors.forename: S
authors.initials: S
authors.lastname: Gatermann
authors.forename: H
authors.initials: H
authors.lastname: Gerlach
authors.forename: B
authors.initials: B
authors.lastname: Grabein
authors.forename: G
authors.initials: G
authors.lastname: Höffken
authors.forename: W V
authors.initials: WV
authors.lastname: Kern
authors.forename: E
authors.initials: E
authors.lastname: Kramme
authors.forename: C
authors.initials: C
authors.lastname: Lange
authors.forename: J
authors.initials: J
authors.lastname: Lorenz
authors.forename: K
authors.initials: K
authors.lastname: Mayer
authors.forename: I
authors.initials: I
authors.lastname: Nachtigall
authors.forename: M
authors.initials: M
authors.lastname: Pletz
authors.forename: G
authors.initials: G
authors.lastname: Rohde
authors.forename: S
authors.initials: S
authors.lastname: Rosseau
authors.forename: B
authors.initials: B
authors.lastname: Schaaf
authors.forename: R
authors.initials: R
authors.lastname: Schaumann
authors.forename: D
authors.initials: D
authors.lastname: Schreiter
authors.forename: H
authors.initials: H
authors.lastname: Schütte
authors.forename: H
authors.initials: H
authors.lastname: Seifert
authors.forename: H
authors.initials: H
authors.lastname: Sitter
authors.forename: C
authors.initials: C
authors.lastname: Spies
authors.forename: T
authors.initials: T
authors.lastname: Welte
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008828:Microbiological Techniques / Q000592:standards*; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015272:Pulmonary Medicine / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents