Download PDF
Pneumologie 2008; 62(5): 297-304
DOI: 10.1055/s-2008-1038146
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Klinik und Diagnose bronchopulmonaler Infektionen im Alter

Clinical Features and Diagnosis of Bronchopulmonary Infections in the ElderlyG.  Hoheisel1 , J.  Winkler2 , C.  Gessner3 , S.  Hammerschmidt4 , H.-J.  Seyfarth4 , A.  C.  Rodloff5 , U.-G.  Liebert6 , H.  Wirtz4 , A.  Gillissen7
  • 1Internistisch-Pneumologische Praxen, Leipzig
  • 2Internistisch-Pneumologische Praxen, Leipzig
  • 3Internistisch-Pneumologische Praxen, Leipzig
  • 4Department Innere Medizin, Abteilung Pneumologie, Universitätsklinikum Leipzig
  • 5Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig
  • 6Institut für Virologie, Universitätsklinikum Leipzig
  • 7Thorax-Zentrum, Klinikum St. Georg eGmbH, Robert Koch-Klinik, Leipzig
Further Information

Publication History

eingereicht 21.11.2007

akzeptiert 14.2.2008

Publication Date:
09 April 2008 (online)

Also available at
   Permissions and Reprints
Preview

Zusammenfassung

Erkrankungen der Lunge sind bei älteren Menschen eine der Hauptursachen von Morbidität und Letalität. Das Risiko von Atemwegsinfektionen ist durch strukturelle Lungenveränderungen, Mangelernährung, Begleiterkrankungen und eine Vielzahl weiterer Faktoren im Alter erhöht. Bakterielle und virale Erreger verursachen akute Bronchitiden und Exazerbationen chronisch obstruktiver Atemwegserkrankungen (AECB). Ambulant erworbene Pneumonien (community acquired pneumonias, CAP) unterscheiden sich von nosokomialen Pneumonien (hospital acquired pneumonia, HAP) durch ihr Erregerspektrum und den Verlauf. Institutionalisierte Patienten sind gefährdet eine health care associated pneumonia (HCAP) zu erleiden, deren Erregerspektrum sich oft von CAP und HAP unterscheidet. Ältere mit zerebrovaskulären Erkrankungen und Beeinträchtigung der Schluck- und Hustenreflexe erleiden häufig eine Aspirationspneumonie. Die Letalität ist bei älteren komorbiden und immunsupprimierten Patienten mit nosokomialen Pneumonien am höchsten. Wichtige Präventivmaßnahmen sind die Influenza- und Pneumokokken-Schutzimpfung, Vermeidung von Immobilität, Mundpflege und ausreichende Ernährung.

Abstract

Diseases of the lung are one of the main causes of morbidity and mortality in the elderly. The risk of respiratory infections is increased due to structural changes, malnutrition, co-morbidity, and a variety of other factors. Bacterial and viral pathogens cause acute bronchitis and exacerbations of chronic bronchitis (AECB). Community acquired pneumonias (CAP) show a different spectrum of pathogens and clinical course in comparison to nosocomial pneumonias (hospital acquired pneumonia, HAP). Institutionalised patients are at risk of a health care associated pneumonia (HCAP), with often a different spectrum of pathogens in comparison to CAP and HAP. Elderly patients with cerebrovascular disease and impairment of swallowing or cough reflexes often suffer from aspiration pneumonias. The mortality is highest in the elderly, comorbid, and immunocompromised patient with nosocomial pneumonia. Important preventive measures include influenza and pneumococcal vaccination, avoidance of immobility, oral hygiene, and sufficient nutrition.

Literatur

  • 1 National Center for Health Statistics .Health, United States, 2004 with chartbook on trends in the health of Americans. Hyattsville MD 2004; http://www.cdc.gov/nchs
    Search in Google Scholar
  • 2 Esposito A L. The effect of common pharmacologic agents on pulmonary antibacterial defenses: implications for the geriatric patient.  Clin Chest Med. 1987;  8 373-380
    Search in Google Scholar
  • 3 Gomez C R, Boehmer E D, Kovacs E J. The aging innate immune system.  Curr Opin Immunol. 2005;  5 457-462
    Search in Google Scholar
  • 4 Meyer K C. Aging.  Proc Am Thorac Soc. 2005;  2 433-439
    Search in Google Scholar
  • 5 Beckham J D, Cadena A, Lin J. et al . Respiratory viral infections in patients with chronic, obstructive pulmonary disease.  J Infect. 2005;  50 322-330
    Search in Google Scholar
  • 6 Falsey A R. Community-acquired viral pneumonia.  Clin Geriatr Med. 2007;  23 535-552, vi
    Search in Google Scholar
  • 7 Murata Y, Walsh E E, Falsey A R. Pulmonary complications of interpandemic influenza A in hospitalized adults.  J Infect Dis. 2007;  195 1029-1037
    Search in Google Scholar
  • 8 Loeb M. Epidemiology of community- and nursing home-acquired pneumonia in older adults.  Expert Rev Anti Infect Ther. 2005;  3 263-270
    Search in Google Scholar
  • 9 Janssens J P, Herrmann F, MacGee W. et al . Cause of death in older patients with anatomo-pathological evidence of chronic bronchitis or emphysema: a case-control study based on autopsy findings.  J Am Geriatr Soc. 2001;  49 571-576
    Search in Google Scholar
  • 10 Chodosh S, McCarty J, Farkas S. et al . Randomized, double-blind study of Ciprofloxacin and cefuroxime axetil for treatment of acute bacterial exacerbations of chronic bronchitis. The Bronchitis Study Group.  Clin Infect Dis. 1998;  27 722-729
    Search in Google Scholar
  • 11 Flamaing J, Engelmann I, Joosten E. et al . Viral lower respiratory tract infection in the elderly: a prospective in-hospital study.  Eur J Clin Microbiol Infect Dis. 2003;  22 720-725
    Search in Google Scholar
  • 12 Creer D D, Dilworth J P, Gillespie S H. et al . Aetiological role of viral and bacterial infections in acute adult lower respiratory tract infection (LRTI) in primary care.  Thorax. 2006;  61 75-79
    Search in Google Scholar
  • 13 Gillissen A, Gessner C, Hammerschmidt S. et al . Akute Bronchitis: wann sind Antibiotika und wann ist eine symptomatische Therapie indiziert?.  MMW Fortschr Med. 2006;  148 26-28
    Search in Google Scholar
  • 14 Worth G, Buhl R, Cegla U. et al . Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD).  Pneumologie. 2003;  56 704-738
    Search in Google Scholar
  • 15 Vogelmeier C, Buhl R, Criée C P. et al . Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD).  Pneumologie. 2007;  61 e1-e40
    Search in Google Scholar
  • 16 Höffken G, Kolditz M, Halank M. Schwere ambulant erworbene Pneumonie.  Chemotherapie J. 2005;  4 97-155
    Search in Google Scholar
  • 17 Seemungal T, Harper-Owen R, Bhowmik A. et al . Respiratory Viruses, Symptoms, and Inflammatory Markers in Acute Exacerbation and Stable Chronic Obstructive Pulmonary Disease.  Am J Respir Crit Care Med. 2001;  164 1618-1623
    Search in Google Scholar
  • 18 Rohde G, Wiethege A, Borg I. et al . Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalization - a case control study.  Thorax. 2003;  58 37-42
    Search in Google Scholar
  • 19 Groenewegen K H, Schols A MWJ, Wouters E FM. Mortality and Mortality-Related Factors After Hospitalization for Acute Exacerbation of COPD.  Chest. 2003;  124 459-467
    Search in Google Scholar
  • 20 Patil S P, Krishnan J A, Lechtzin N. et al . In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease.  Arch Intern Med. 2003;  163 1180-1186
    Search in Google Scholar
  • 21 Höffken G, Lorenz L, Kern W. et al . S3-Leitlinie zu ambulant erworbener Pneumonien und tiefen Atemwegsinfektionen. Leitlinie der Paul-Ehrlich-Gesellschaft für Chemotherapie, der Deutschen Gesellschaft für Pneumologie, der Deutschen Gesellschaft für Infektiologie und vom Kompetenznetzwerk CAPNETZ.  Pneumologie. 2005;  59 612-664
    Search in Google Scholar
  • 22 Anon J M, Garcia d L, Zarazaga A. et al . Mechanical Ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis.  Intensive Care Med. 1999;  25 452-457
    Search in Google Scholar
  • 23 Woolhouse I S, Hill S L, Stockley R A. Symptom resolution assessed using a patient directed diary card during treatment of acute exacerbations of chronic bronchitis.  Thorax. 2001;  56 947-953
    Search in Google Scholar
  • 24 Donaldson G C, Seemungal T A, Bhowmik A. et al . Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.  Thorax. 2002;  57 847-852
    Search in Google Scholar
  • 25 Papi A, Bellettato C M, Braccioni F. et al . Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations.  Am J Respir Crit Care Med. 2006;  173 1114-1121
    Search in Google Scholar
  • 26 Wilkinson T M, Hurst J R, Perera W R. et al . Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD.  Chest. 2006;  129 317-324
    Search in Google Scholar
  • 27 Schmidt-Ioanas M, Lode H. Treatment of pneumonia in elderly patients.  Expert Opin Pharmacother.. 2006;  7 499-507
    Search in Google Scholar
  • 28 Metlay J P, Fine M J, Schulz R. et al . Measuring symptomatic and functional recovery in patients with community-acquired pneumonia.  J Gen Intern Med. 1997;  12 423-430
    Search in Google Scholar
  • 29 Metlay J P, Schulz R, Li Y H. et al . Influence of age on Symptoms at presentation in patients with community-acquired pneumonia.  Arch Intern Med. 1997;  157 1453-1459
    Search in Google Scholar
  • 30 Ewig S. Community-acquired pneumonia: epidemiology, risk, and prognosis. In: Torres A, Woodhead M (Hrsg). Pneumonia. Sheffield: European Respiratory Society Journals Ltd 1997: 13-35
    Search in Google Scholar
  • 31 Macfarlane J T. An overview of community-acquired pneumonia with lessons learned from the British Thoracic Society study.  Semin Respir Infect. 1994;  9 153-165
    Search in Google Scholar
  • 32 Finkelstein M S, Petkun W M, Freedman M L. et al . Pneumococcal bacteremia in adults: age-dependent differences in presentation and in out come.  J Am Geriatr Soc. 1983;  31 19-27
    Search in Google Scholar
  • 33 Fine M J, Smith D N, Singer D E. Hospitalization decision in patients with community-acquired pneumonia: a prospective cohort study.  Am J Med. 1990;  89 713-721
    Search in Google Scholar
  • 34 Bates J H, Campbell G D, Barron A L. et al . Microbial etiology of acute pneumonia in hospitalized patients.  Chest. 1992;  101 1005-1012
    Search in Google Scholar
  • 35 Niederman M S, Bass J B, Campbell G D. et al . Guidelines of the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. Official statement of the American Thoracic Society.  Am Rev Respir Dis. 1993;  148 1418-1426
    Search in Google Scholar
  • 36 Höffken G, Steinhoff D, Lode H. et al . Ätiologie von ambulant erworbenen Pneumonien bei älteren Menschen.  Chemotherapie J. 1995;  4 13-19
    Search in Google Scholar
  • 37 García-Ordóñez M A, García-Jiménez J M, Páez F. et al . Clinical aspects and prognostic factors in elderly patients hospitalised for community-acquired pneumonia.  Eur J Clin Microbiol Infect Dis. 2001;  20 14-19
    Search in Google Scholar
  • 38 Woodhead M, Ortqvist A. Pulmonary infections: what to do when it's a bug that you do not know.  Eur Respir J. 2003;  21 201
    Search in Google Scholar
  • 39 Riquelme R, Torres A, el-Ebiary M. et al . Community-acquired pneumonia in the elderly. clinical and nutritional aspects.  Am J Respir Crit Care Med. 1997;  156 1908-1914
    Search in Google Scholar
  • 40 Arancibia F, Bauer T T, Ewig S. et al . Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: incidence, risk, and prognosis.  Arch Intern Med. 2002;  162 1849-58
    Search in Google Scholar
  • 41 Falsey A R. Respiratory syncytial virus infection in adults.  Semin Respir Crit Care Med. 2007;  28 171-181
    Search in Google Scholar
  • 42 Falsey A R, Hennessey P A, Formica M A. et al . Respiratory syncytial virus infection in elderly and high-risk adults.  N Engl J Med. 2005;  352 1749-1759
    Search in Google Scholar
  • 43 Deffrasnes C, Hamelin M E, Boivin G. Human metapneumovirus.  Semin Respir Crit Care Med. 2007;  28 213-221
    Search in Google Scholar
  • 44 Kikuta H. Human metapneumovirus.  Uirusu. 2006;  56 173-181
    Search in Google Scholar
  • 45 Falsey A R, Walsh E E. Viral pneumonia in older adults.  Clin Infect Dis. 2006;  42 518-524
    Search in Google Scholar
  • 46 de Roux A, Ewig S, Garcia E. et al . Mixed community-acquired pneumonia in hospitalised patients.  Eur Respir J. 2006;  27 795-800
    Search in Google Scholar
  • 47 de Roux A, Marcos M A, Garcia E. et al . Viral community-acquired pneumonia in non-immunocompromised adults.  Chest. 2004;  125 1343-1351
    Search in Google Scholar
  • 48 Hak E, Verheij T J, Essen G A van. et al . Prognostic factors for influenza-associated hospitalization and death during an epidemic.  Epidemiol Infect. 2001;  126 261-268
    Search in Google Scholar
  • 49 Schaberg T. Diagnosis, therapy, and prevention of influenza.  Pneumologie. 2003;  57 27-33
    Search in Google Scholar
  • 50 Lee N, Hui D, Wu A. et al . A major outbreak of severe acute respiratory syndrome in Hong Kong.  N Engl J Med. 2003;  348 1986-1994
    Search in Google Scholar
  • 51 Tsang K W, Ho P L, Ooi G C. et al . A cluster of cases of severe acute respiratory syndrome in Hong Kong.  N Engl J Med. 2003;  348 1977-1985
    Search in Google Scholar
  • 52 Hoheisel G, Wu A, Lee N. et al . Schweres akutes respiratorische Syndrom (SARS).  Pneumologie. 2003;  57 315-321
    Search in Google Scholar
  • 53 Hoheisel G, Luk W K, Winkler J. et al . Schweres Akutes Respiratorisches Syndrom (SARS).  Med Klin (Munich). 2006;  101 957-963
    Search in Google Scholar
  • 54 Hui D S. An overview on severe acute respiratory syndrome (SARS).  Monaldi Arch Chest Dis. 2005;  63 149-157
    Search in Google Scholar
  • 55 Yuen K Y, Chan P K, Peiris M. et al . Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus.  Lancet. 1998;  351 467-471
    Search in Google Scholar
  • 56 Beigel J H, Farrar J, Han A M. et al . Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5: Avian influenza A (H5N1) infection in humans.  N Engl J Med. 2005;  353 1374-1385
    Search in Google Scholar
  • 57 Ewig S, de Roux A, Bauer T. et al . Validation of predictive rules and indices of severity for community acquired pneumonia.  Thorax. 2004;  59 421-427
    Search in Google Scholar
  • 58 Clavo-Sánchez A J, Girón-González J A, López-Prieto D. et al . Multivariate analysis of risk factors for infection due to penicillin-resistant and multidrug-resistant Streptococcus pneumoniae: A multicenter study.  Clin Infect Dis. 1997;  24 1052-1059
    Search in Google Scholar
  • 59 Ewig S, Torres A, Angeles Marcos M. et al . Factors associated with unknown aetiology in patients with community-acquired pneumonia.  Eur Respir J. 2002;  20 1254-1262
    Search in Google Scholar
  • 60 Marrie T. Normal resolution of community-acquired pneumonia.  Semin Respir Infect. 1992;  7 289-293
    Search in Google Scholar
  • 61 Mittl R L, Schwab R J, Duchin J S. et al . Radiographic resolution of community-acquired pneumonia.  Am J Respir Crit Care Med. 1994;  149 630-635
    Search in Google Scholar
  • 62 El Solh A A, Aquilina A T, Gunen H. et al . Radiographic resolution of community-acquired bacterial pneumonia in the elderly.  J Am Geriatr Soc. 2004;  52 224-229
    Search in Google Scholar
  • 63 Metlay J P, Kapoor W N, Fine M J. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination.  JAMA. 1997;  278 1440-1445
    Search in Google Scholar
  • 64 The British Thoracic Society Research Committee and The Public Health Laboratory Service . The aetiology, management and outcome of severe community-acquired pneumonia on the intensive care unit.  Respir Med. 1992;  86 7-13
    Search in Google Scholar
  • 65 Feinsilver S H, Fein A M, Niederman M S. et al . Utility of fiberoptic bronchoscopy in non-resolving pneumonia.  Chest. 1990;  98 1322-1326
    Search in Google Scholar
  • 66 Ruiz M, Ewig S, Marcos M A. et al . Etiology of community-acquired pneumonia in hospitalized patients: Impact of age, comorbidity and severity.  Am J Respir Crit Care Med. 1999;  159 A559
    Search in Google Scholar
  • 67 Ruiz M, Ewig S, Torres A. et al . Severe community-acquired pneumonia. Risk factors and follow-up epidemiology.  Am Respir Crit Care Med. 1999;  160 923-929
    Search in Google Scholar
  • 68 Ewig S, Ruiz M, Mensa J. et al . Severe community-acquired pneumonia: Assessment of severity criteria.  Am J Respir Crit Care Med. 1998;  158 1102-1108
    Search in Google Scholar
  • 69 Kuru T, Lyons J P3. Nonresolving or slowly resolving pneumonia.  Clin Chest Med. 1999;  20 623-651
    Search in Google Scholar
  • 70 Mody L, Sun R, Bradley S F. Assessment of pneumonia in older adults: effect of functional status.  J Am Geriatr Soc. 2006;  54 1062-1067
    Search in Google Scholar
  • 71 Fine M J, Auble T E, Yealy D M. et al . A prediction rule to identify low-risk patients with community-acquired pneumonia.  N Engl J Med. 1997;  336 243-250
    Search in Google Scholar
  • 72 The British Thoracic Society . BTS Guidelines for the Management of Community Acquired Pneumonia in Adults.  Thorax. 2001;  56 liv-64
    Search in Google Scholar
  • 73 Neill A M, Martin I R, Weir R. et al . Community-acquired pneumonia: aetiology and usefulness of severity criteria on admission.  Thorax. 1996;  51 1010-1016
    Search in Google Scholar
  • 74 Halm E A, Fine M J, Marrie T J. et al . Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines.  JAMA. 1998;  279 1452-1457
    Search in Google Scholar
  • 75 Welte T. Community-acquired and nosocomial pneumonia.  Internist. 2003;  44 44-58
    Search in Google Scholar
  • 76 Janssens J P. Pneumonia in the elderly (geriatric) population.  Curr Opin Pulm Med. 2005;  11 226-230
    Search in Google Scholar
  • 77 Saldias Penafiel F, O'Brien Solar A, Gederlini Gollerino A. et al . Community-acquired pneumonia requiring hospitalization in immunocompetent elderly patients: clinical features, prognostic factors and treatment.  Arch Bronco pneumol. 2003;  39 333-340
    Search in Google Scholar
  • 78 Pascual F E, Matthay M A, Bacchetti P. et al . Assessment of prognosis in patients with community-acquired pneumonia who require mechanical ventilation.  Chest. 2000;  117 503-512
    Search in Google Scholar
  • 79 Hauer T, Lacour M, Gastmeier P. et al . Nosokomiale Infektionen in Deutschland (NIDEP).  Med Klinik. 1996;  91 681-686
    Search in Google Scholar
  • 80 Rüden H, Gastmeier P, Wischnewski N. et al . Prävalenz der wichtigsten nosokomialen Infektionen in Deutschland, Ergebnisse der NIDEP-Studie.  Bundesgesundheitsblatt. 1997;  6 198-203
    Search in Google Scholar
  • 81 Steinbrecher E, Sohr D, Nassauer A. et al . Die häufigsten Erreger bei Intensivpatienten mit nosokomialen Infektionen, Ergebnisse des Krankenhaus-Infektions-Surveillance-Systems (KISS).  Chemotherapie Journal. 2000;  5 179-184
    Search in Google Scholar
  • 82 Lorenz J, Bodmann K F, Bauer T T. et al . Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI).Nosokomiale Pneumonie, Prävention, Diagnose, Therapie.  Pneumologie. 2003;  57 532-545
    Search in Google Scholar
  • 83 The Canadian Critical Care Trials Group . A Randomized Trial of Diagnostic Techniques for Ventilator-Associated Pneumonia.  N Engl J Med. 2006;  355 2619-2630
    Search in Google Scholar
  • 84 Abdallah A, Rowland K E, Schepetiuk S K. et al . An outbreak of respiratory syncytial virus infection in a bone marrow transplant unit: effect on engraftment and outcome of pneumonia without specific antiviral treatment.  Bone Marrow Transplant. 2003;  32 195-203
    Search in Google Scholar
  • 85 Oliveira E C, Lee B, Colice G L. Influenza in the intensive care unit.  J Intensive Care Med. 2003;  18 80-91
    Search in Google Scholar
  • 86 Daubin C, Vincent S, Vabret A. et al . Nosocomial viral ventilator-associated pneumonia in the intensive care unit: a prospective cohort study.  Intensive Care Med. 2005;  31 1116-1122
    Search in Google Scholar
  • 87 Dalhoff K, Ewig S, Höffken G. et al . Recommendations for the diagnosis, therapy and prevention of pneumonia in the immunocompromised host German Pathology Society.  Pneumologie. 2002;  56 807-831
    Search in Google Scholar
  • 88 Hoheisel G, Lange S, Winkler J. et al . Nosokomiale Pneumonien bei hämatologischen Malignomen in der internistischen Intensivmedizin.  Pneumologie. 2003;  57 73-77
    Search in Google Scholar
  • 89 Winkler J, Müller U, Nenoff P. et al . Treatment of invasive pulmonary aspergillosis in neutropenic patients by additional bronchoscopic amphotericin B instillation.  Respiration. 2007;  74 663-673
    Search in Google Scholar
  • 90 Ewig S, Dalhoff K, Lorenz J. et al . Nosokomiale Pneumonie: Empfehlungen zur Therapie und Prophylaxe.  Pneumologie. 2000;  54 525-538
    Search in Google Scholar
  • 91 Celis R, Torres A, Gatell J M. et al . Nosocomial pneumonia. A multivariate analysis of risk and prognosis.  Chest. 1988;  93 318-324
    Search in Google Scholar
  • 92 Torres A, Aznar R, Gatell J M. et al . Incidence, risk, and prognostic factors of nosocomial pneumonia in mechaniccally ventilated patients.  Am Rev Respir Dis. 1990;  142 523-528
    Search in Google Scholar
  • 93 Bodmann K F, Lorenz J, Bauer T T. et al . Nosokomiale Pneumonie: Prävention, Diagnostik und Therapie. Ein Konsensuspapier der Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG) und der Deutschen Gesellschaft für Pneumologie (DGP) unter Mitarbeit von Experten der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI).  Chemotherapie J. 2003;  12 33-44
    Search in Google Scholar
  • 94 Rello J, Quintana E, Ausina V. et al . Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients.  Chest Vol. 1991;  100 439-444
    Search in Google Scholar
  • 95 Fagon J Y, Chastre J, Vuagnat A. et al . Nosocomial pneumonia and mortality among patients in intensive care units.  JAMA. 1996;  275 866-869
    Search in Google Scholar
  • 96 Kollef M H. Ventilator-associated pneumonia. A multivariate analysis.  JAMA. 1993;  270 1965-1970
    Search in Google Scholar
  • 97 Papazian L, Bregeon F, Thirion X. et al . Effect of ventilator-associated pneumonia on mortality and morbidity.  Am J Respir Crit Care Med. 1997;  154 91-97
    Search in Google Scholar
  • 98 Carratalà J, Mykietiuk A, Fernández-Sabé N. et al . Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes.  Arch Intern Med. 2007;  167 1393-1399
    Search in Google Scholar
  • 99 Kollef M H, Shorr A, Tabak Y P. et al . Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia.  Chest. 2005;  128 3854-3862
    Search in Google Scholar
  • 100 Micek S T, Kollef K E, Reichley R M. et al . Health care-associated pneumonia and community-acquired pneumonia: a single-center experience.  Antimicrob Agents Chemother.. 2007;  51 3568-3573
    Search in Google Scholar
  • 101 Ohrui T. Preventive strategies for aspiration pneumonia in elderly disabled persons.  Tohoku J Exp Med. 2005;  207 3-12
    Search in Google Scholar
  • 102 Paju S, Scannapieco F A. Oral biofilms, periodontitis, and pulmonary infections.  Oral Diseases. 2007;  13 508-512
    Search in Google Scholar
  • 103 Didilescu A C, Skaug N, Marica C. et al . Respiratory pathogens in dental plaque of hospitalized patients with chronic lung diseases.  Clin Oral Invest. 2005;  9 141-147
    Search in Google Scholar
  • 104 Hennessy S, Bilker W B, Leonard C E. et al . Observed association between antidepressant use and pneumonia risk was confounded by comorbidity measures.  J Clin Epidemiol. 2007;  60 911-918
    Search in Google Scholar
  • 105 Smithard D G, O'Neill P A, Park C. et al . North West Dysphagia Group. Can bedside assessment reliably exclude aspiration following acute stroke?.  Age Ageing. 1998;  27 99-106
    Search in Google Scholar
  • 106 Quagliarello V, Ginter S, Han L. et al . Modifiable risk factors for nursing home-acquired pneumonia.  Clin Infect Dis. 2005;  40 7-8
    Search in Google Scholar
  • 107 El-Solh A A, Pietrantoni C, Bhat A. et al . Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders.  Chest. 2004;  126 1575-1582
    Search in Google Scholar
  • 108 Watando A, Ebihara S, Ebihara T. et al . Daily oral care and cough reflex sensitivity in elderly nursing home patients.  Chest. 2004;  126 1066-1070
    Search in Google Scholar
  • 109 El Solh A A, Pietrantoni C, Bhat A. et al . Microbiology of severe aspiration pneumonia in institutionalized elderly.  Am J Respir Crit Care Med. 2003;  167 1650-1654
    Search in Google Scholar
  • 110 Brandt H E, Ooms M E, Deliens L. et al . The last two days of life of nursing home patients - a nationwide study on causes of death and burdensome symptoms in The Netherlands.  Palliat Med. 2006;  20 533-540
    Search in Google Scholar
  • 111 Abdel-Karim I A, Sammel R B, Prange M A. Causes of death at autopsy in an inpatient hospice program.  J Palliat Med 2007. Aug ;  10 (4) 894-898
    Search in Google Scholar
  • 112 Skull S A, Andrews R M, Byrnes G B. et al . Prevention of community-acquired pneumonia among a cohort of hospitalized elderly: benefit due to influenza and pneumococcal vaccination not demonstrated.  Vaccine. 2007;  25 4631-4640
    Search in Google Scholar

Priv.-Doz. Dr. med. Gerhard Hoheisel

August-Bebel-Str. 69

04275 Leipzig

Email: gerhard.hoheisel@t-online.de