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Ambulant erworbene Pneumonie

Rationale Behandlungsplanung in Abhängigkeit vom Schweregrad

Community-acquired pneumonia

Rational treatment planning depends on the degree of severity

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Zusammenfassung

Die ambulant erworbene Pneumonie („community acquired pneumonia“, CAP) ist eine häufige Infektionserkrankung, die mit einer hohen Morbidität und Letalität verbunden ist. Da die Behandlungskosten, besonders im stationären Bereich, erheblich sind, ist ein schweregradbezogenes Behandlungskonzept im ambulanten sowie im stationären Bereich wichtig. Die Entscheidung zur ambulanten oder stationären Behandlung eines Patienten untersucht der Fine- und der CRB-65-Score, beide identifizieren gut eine leichtgradige Verlaufsform der CAP. Patienten der Gruppe I und II nach Fine oder ohne Risikofaktoren nach CRB-65 weisen eine niedrige Letalität auf und können ambulant behandelt werden. Die Frage der Aufnahme auf die Intensivstation beantwortet am besten der modifizierte ATS-Score. Wenn 1 von 2 Majorkriterien oder 2 von 3 Minorkriterien zutreffen, besteht eine Indikation zur intensivmedizinischen Behandlung und/oder Beobachtung. Insgesamt muss bei bislang noch fehlenden prospektiven Studien nach dem klinischem Eindruck des Patienten und der Erfahrung des Arztes individuell vorgegangen werden.

Abstract

Community-acquired pneumonia (CAP) is a widespread disease with high comorbidity and mortality. As the costs of CAP, especially regarding hospitalization, are high, treatment concepts according to the degree of severity are necessary for both hospitalized and outpatients. Non-severe cases can be identified with the Fine or the CRB-65 score for both groups of patients. Groups I and II according to Fine or groups without any risk factors according to CRB-65 imply mild disease associated with a low mortality. These patients do not necessarily need to receive hospital treatment. Necessity for treatment under intensive care conditions is best identified by the modified ATS score. The presence of one of the two major criteria or two of the three minor criteria can be considered an indication for intensive care treatment or observation. Since none of the scoring systems has been validated prospectively, an individual approach depending on the experience of the treating physician and the clinical picture of the patients remains the gold standard.

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Authors and Affiliations

  1. Berufsgenossenschaftliche Kliniken Bergmannsheil, Klinikum der Ruhr-Universität Bochum, Medizinische Klinik III, Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin

    B. M. Schlosser, G. Rohde, E. Marchel, M. Orth & T. T. Bauer

  2. Berufsgenossenschaftliche Kliniken Bergmannsheil, Klinikum der Ruhr-Universität Bochum, Medizinische Klinik III, Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Bürkle-de-la-Camp-Platz 1, 44791, Bochum

    B. M. Schlosser

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  1. B. M. Schlosser
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  2. G. Rohde
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  3. E. Marchel
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  4. M. Orth
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  5. T. T. Bauer
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Correspondence to B. M. Schlosser.

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Schlosser, B.M., Rohde, G., Marchel, E. et al. Ambulant erworbene Pneumonie. Pneumologe 2, 28–33 (2005). https://doi.org/10.1007/s10405-004-0021-0

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  • DOI: https://doi.org/10.1007/s10405-004-0021-0

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