title: Adult patients with nosocomial pneumonia: epidemiology, diagnosis, and treatment.
abstract: BACKGROUND
  Nosocomial pneumonia is among the most common types of infection in hospitalized patients. The increasing prevalence of multi-drug resistant organisms (MDROs) in recent years points to the need for an up-to-date clinical guideline.
  
  
  METHODS
  An interdisciplinary S3 guideline was created on the basis of a systematic literature review in the PubMed and Cochrane Library databases, with assessment and grading of the evidence according to the GRADE system.
  
  
  RESULTS
  9097 abstracts and 808 articles were screened in full text, and 22 recommendations were issued. It is recommended that any antimicrobial treatment should be preceded by a microbiological diagnostic evaluation with cultures of blood and respiratory samples. The diagnosis of nosocomial pneumonia should be suspected in any patient with a new or worsened pulmonary infiltrate who meets any two of the following three criteria: leucocyte count above 10,000 or below 4000/µL, temperature above 38.3°C, and/or the presence of purulent respiratory secretions. The initially calculated antimicrobial treatment should be begun without delay; it should be oriented to the locally prevailing resistance pattern, and its intensity should be a function of the risk of infection with MDROs. The initial treatment should be combination therapy if there is a high risk of MDRO infection and/or if the patient is in septic shock. In the new guideline, emphasis is laid on a strict de-escalation concept. In particular, antimicrobial treatment usually should not be continued for longer than eight days.
  
  
  CONCLUSIONS
  The new guideline's recommendations are intended to encourage rational use of antibiotics, so that antimicrobial treatment will be highly effective while the unnecessary selection of multi-drug-resistant organisms will be avoided.
authors.affiliation: Department of Pulmonology, University Medical Center Schleswig-Holstein, Campus Lübeck.
authors.forename: Klaus
authors.initials: K
authors.lastname: Dalhoff
authors.forename: Santiago
authors.initials: S
authors.lastname: Ewig
authors.forename: Marianne
authors.initials: M
authors.lastname: Abele-Horn
authors.forename: Stefan
authors.initials: S
authors.lastname: Andreas
authors.forename: Torsten T
authors.initials: TT
authors.lastname: Bauer
authors.forename: Heike
authors.initials: H
authors.lastname: von Baum
authors.forename: Maria
authors.initials: M
authors.lastname: Deja
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.forename: Sören
authors.initials: S
authors.lastname: Gatermann
authors.forename: Herwig
authors.initials: H
authors.lastname: Gerlach
authors.forename: Beatrice
authors.initials: B
authors.lastname: Grabein
authors.forename: Gert
authors.initials: G
authors.lastname: Höffken
authors.forename: Winfried
authors.initials: W
authors.lastname: Kern
authors.forename: Evelyn
authors.initials: E
authors.lastname: Kramme
authors.forename: Christoph
authors.initials: C
authors.lastname: Lange
authors.forename: Joachim
authors.initials: J
authors.lastname: Lorenz
authors.forename: Konstantin
authors.initials: K
authors.lastname: Mayer
authors.forename: Irit
authors.initials: I
authors.lastname: Nachtigall
authors.forename: Matthias
authors.initials: M
authors.lastname: Pletz
authors.forename: Gernot
authors.initials: G
authors.lastname: Rohde
authors.forename: Simone
authors.initials: S
authors.lastname: Rosseau
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schaaf
authors.forename: Reiner
authors.initials: R
authors.lastname: Schaumann
authors.forename: Dirk
authors.initials: D
authors.lastname: Schreiter
authors.forename: Hartwig
authors.initials: H
authors.lastname: Schütte
authors.forename: Harald
authors.initials: H
authors.lastname: Seifert
authors.forename: Helmut
authors.initials: H
authors.lastname: Sitter
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015272:Pulmonary Medicine / Q000592:standards*; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents