Community-acquired and nosocomial pneumonia

Mortality of pneumonia is low in the outside setting (1%) but rises up to 20% in hospital admitted patients. Early diagnosis and standardized therapy improve patient's prognosis. For community acquired pneumonia age, comorbidity and the setting of therapy (outside department, normal ward or intensive care unit) are the most important variables to choose an adequate antibiotic treatment. For nosocomial pneumonia risk stratification is according to severity of illness, length of hospital stay and antibiotic pretreatment. In the outpatient setting a 7-day monotherapy is mostly successful. In severe illness the combination of a betalactam antibiotic with a new fluorchinolon seems to be superior to an aminoglycosid therapy. Antibiotic resistance due to mistakes in antibiotic therapy is an increasing problem in the intensive care unit. Therefore, pneumonia preventive measures like influenza and pneumococcal vaccination become more important. Standardized hygienical procedures help to reduce nosocomial, mainly ventilator associated pneumonia.