Nosocomial pneumonia

Case report:

A 64 year old patient with a long smoking history developed on the third day after a colon resection due to a tumor fever, cough, purulent sputum and chest pain rechtsbasale. Clinically can auscultate over the right lower lobe dorsol-lateral sounding rales that an infiltration into the lateral and dorsal lower lobe segments correspond radiographically right.

Diagnosis:

The course of the disease and the collected clinical findings suggest a postoperative nosocomial pneumonia of the right lung lower lobe. The X-ray image with a confluent infiltration in two segments of the lower lobe without evidence of melting confirmed this suspicion. In blood, there is a leukocytosis of 15,000 / ul with indicated left shift, the CRP value is increased by 33 mg / l. Microbiological testing of purulent sputum results in a growth of Klebsiella pneumoniae.

Pathogenesis:

The nearly three-hour surgical procedure and the postoperative pain-related restricted diaphragmatic have led to the patient with a smoking-related chronic bronchitis to a fault of his bronchoalveolar clearance and thus the disposition with respect to a nosocomial pneumonia ( or Hospital-acquired pneumonia). An essential aspiration was not observed, and is today in modern anesthetic procedures a rarity. As agents in such infections that occur in the early phase of hospitalization, coming in patients with chronic bronchitis quite germs such as pneumococci, Haemophilus influenzae and Staphylococcus aureus, as well as Klebsiella, Enterobacter, and Proteus species into consideration. An anaerobic bacteria must be considered in planning and proven aspiration.

Therapy:

Of particular importance in this postoperative infection is the restoration of an undisturbed respiratory mechanics with pain management and respiratory physical measures such as physiotherapy respiratory therapy, bronchospasmolytic treatment and possibly IPPB a IPPB device. Antimicrobial the aforementioned dominant germs must be considered in the empirical initial treatment so that parenteral cephalosporins of the second generation [e.g. Cefotiam (SPIZEF)] or cefuroxime (CEFUROXIME others), broad-spectrum penicillins such as amoxicillin plus clavulanic acid (Augmentin), ampicillin plus sulbactam (UNACID) mezlocillin (BAYPEN) plus sulbactam (COMBACTAM) or piperacillin plus tazobactam (TAZOBAC), piperacillin (PIPRIL ) as well as fluoroquinolones such as ciprofloxacin (Cipro), levofloxacin (Tavanic) or moxifloxacin (Avelox) can be used. The antibiotic therapy is performed parenterally to defervescence, then can be converted to an oral treatment. The duration of therapy depends on the clinical course and is usually between five and ten days.