Antibiotic Stewardship und Pneumonie

Pneumonia is a very frequent and potentially fatal disease. It can be classified into 3 different entities, community-acquired (CAP), hospital-acquired (HAP) and pneumonia in immunosuppressed patients. The CAP and HAP are primarily eligible for antibiotic stewardship (ABS) interventions, strategies to enhance the rational use of antibiotic agents. In patients hospitalized with pneumonia, microbiological testing is strongly recommended before starting antibiotic treatment. A risk stratification of patients and grading of the severity of pneumonia is crucial for the calculated choice of antibiotics and the mode of administration. In patients with coronavirus disease 2019 (COVID-19) without septic shock, bacterial superinfections are rare and usually do not require empirical antibiotic treatment. After 48–72 h the antibiotic treatment strategy needs to be re-evaluated and a targeted de-escalated treatment should be implemented taking the clinical status and microbiology into consideration. Stopping calculated treatment in cases of misdiagnosis and limiting the duration of antibiotic treatment are essential ABS strategies to optimize the clinical outcome in patients with CAP and HAP and to keep the development of antibiotic resistance and drug toxicity as low as possible. In certain situations, the use of a biomarkers for bacterial infections, e.g. procalcitonin, can support the early discontinuation of antibiotics or the diagnosis of bacterial superinfections in COVID-19.