Klinik und Diagnose bronchopulmonaler Infektionen im Alter

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.

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