Ambulant erworbene Pneumonie

Was ist neu?

Risikofaktoren für schwere Verläufe Als Risikoprädiktor wird der CRB-65-Score empfohlen sowie die Berücksichtigung instabiler Komorbiditäten und der Oxygenierung.

Gruppeneinteilung der ambulant erworbenen Pneumonie Die ambulant erworbene Pneumonie wird in 3 Gruppen eingeteilt: leichte Pneumonie, mittelschwere Pneumonie, schwere Pneumonie. Ob ein kuratives vs. palliatives Behandlungsziel besteht, sollte frühzeitig festgelegt werden.

Diagnostikempfehlung Zur Sicherung der Diagnose wird eine Röntgen-Thoraxaufnahme empfohlen, möglichst auch im ambulanten Bereich. Alternativ kann eine Sonografie des Thorax durchgeführt werden, wobei bei negativem Befund weitere Bildgebung empfohlen wird. Streptococcus pneumoniae ist weiterhin der häufigste bakterielle Erreger.

Therapie Die ambulant erworbene Pneumonie ist nach wie vor mit hoher Morbidität und Letalität assoziiert. Eine zügige Diagnosestellung und die umgehende Einleitung einer risikoadaptierten antimikrobiellen Therapie stellen wesentliche Maßnahmen dar. In Zeiten von COVID-19, aber auch der aktuellen Influenza- und RSV-Epidemie, muss aber auch mit rein viralen Pneumonien gerechnet werden. Zumindest bei COVID-19 kann häufig auf ein Antibiotikum verzichtet werden. Antivirale und entzündungshemmende Medikamente werden hier eingesetzt.

Postakuter Verlauf Patienten nach ambulant erworbener Pneumonie haben eine erhöhte Akut- und Langzeitletalität – aufgrund von insbesondere kardiovaskulären Ereignissen. Das Augenmerk der Forschung liegt auf verbesserter Erregererkennung, einem besseren Verständnis der Wirtsantwort, mit dem Potenzial der Entwicklung spezifischer Therapeutika, der Rolle von Komorbiditäten und den Langzeitfolgen der akuten Erkrankung.

What is new?

Risk factors for severe courses The CRB-65 score is recommended as a risk predictor, as well as consideration of unstable comorbidities and oxygenation.

Grouping of community-acquired pneumonia Community-acquired pneumonia is divided into 3 groups: mild pneumonia, moderate pneumonia, severe pneumonia. Whether there is a curative vs palliative treatment goal should be determined early.

Diagnostic recommendation An X-ray chest radiograph is recommended to confirm the diagnosis, also in the outpatient setting if possible. Sonography of the thorax is an alternative, asking for additional imaging if negative. Streptococcus pneumoniae remains the most common bacterial pathogen.

Therapy Community-acquired pneumonia continues to be associated with high morbidity and lethality. Prompt diagnosis and prompt initiation of risk-adapted antimicrobial therapy are essential measures. However, in times of COVID-19, as well as the current influenza and RSV epidemic, purely viral pneumonias must also be expected. At least with COVID-19, antibiotics can often be avoided. Antiviral and anti-inflammatory drugs are used here.

Post-acute course Patients after community-acquired pneumonia have increased acute and long-term mortality due to cardiovascular events in particular. The focus of research is on improved pathogen identification, a better understanding of the host response with the potential of developing specific therapeutics, the role of comorbidities, and the long-term consequences of the acute illness.

Schlüsselwörter

ambulant erworbene Pneumonie - Risikofaktoren - Leitlinie - Diagnostik - Therapie

Keywords

community-acquired pneumonia - risk factors - guideline - diagnostics - therapy

Publication History

Article published online:
06 March 2023

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