Aspiration pneumonia: management in Germany

Abstract

In Germany, 65.54% of all patients with community-acquired pneumonia treated as inpatients are older than 70 years. For every case of community-acquired pneumonia treated in a hospital, the hospital has to report details and outcomes to the federal institute for quality management. The in-hospital mortality of patients with community-acquired pneumonia is compared to other hospitals every year. Dysphagia is assessed systematically in patients with acute stroke and in other diseases when clinically feasible. The German Guideline for Nutrition of patients with acute stroke recommends follow up assessment of the dysphagia at least every week and before discharge. It depends on the local structure of the hospital where a patient with aspiration pneumonia is admitted. Options are a Department for General Internal Medicine, a Department for Pneumology or a Geriatric Department. The mean length of stay for patients with community-associated pneumonia was 11.8 days in the year 2005.The mortality increases with age. Patients admitted from nursing homes have a higher mortality than patients living in the community. In 6.9% of patients with community-acquired pneumonia, the antibiotic therapy was not initiated or was stopped in consent with the patient or with the caregiver because of severe comorbidity. In Germany, the follow up of the patient after discharge is normally done by primary care physicians. Patients living in a nursing home are also cared by a primary care physician, usually a general practitioner. Only very few primary care physicians have a formal training in Geriatrics.