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Dalhoff, K.; Abele-Horn, M.; Andreas, S.; Deja, M.; Ewig, S.; Gastmeier, P.; Gatermann, S.; Gerlach, H.; Grabein, B.; Heussel, C. P.; Hoeffken, G.; Kolditz, M.; Kramme, E.; Kuehl, H.; Lange, C.; Mayer, K.; Nachtigall, I.; Panning, M.; Pletz, M.; Rath, P-M.; Rohde, G.; Rosseau, S.; Schaaf, B.; Schreiter, D.; Schütte, H.; Seifert, H.; Spies, C. and Welte, T. (2018): Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie – Update 2017. In: Pneumologie, Vol. 72, No. 1: pp. 15-63

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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 increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy. This guideline update 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 treatment of HAP on the basis of quality of evidence and benefit/risk ratio. This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.

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