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We thank Panning and coauthors for their letter, which provides us with an opportunity for emphasizing the importance of nosocomial respiratory infections caused by viruses. In the abbreviated version of our guideline published in Deutsches Ärzteblatt this was not possible due to space constraints. In the long version (1), however, we focused—in the chapter on the spectrum of pathogens—on the importance especially of influenza, and in the explanation of recommendation E7 (microbiological testing), we advise virological testing in patients in whom a virus is the suspected pathogen.

We also agree with our correspondents that more evidence on the subject should become available thanks to the now more widely available molecular biological tests. However, fully published studies on viral etiologies of nosocomial pneumonia are still lacking. The study reported by Giannella et al., which our correspondents cite, can at best be regarded as a pilot study: in 31 of 105 intubated patients with suspected lower respiratory tract infection, whose endotracheal aspirates were sent for analysis, influenza was identified during the flu season. But this had been acquired nosocomially in only 13 cases; furthermore, the manuscript does not provide any information on how many of the subjects did have pneumonia (2). We hope that more published data on the subject will be available by the time the updated guideline is published, at the end of 2014.

With regard to the particular importance of flu prevention and emerging viral infections, we can only agree with our correspondents; in this respect, the guideline, which deals exclusively with the epidemiology, diagnostic evaluation, and treatment of nosocomial pneumonia, refers readers to the relevant publications from the German Respiratory Society (3) and the Robert Koch Institute (www.rki.de).

DOI: 10.3238/arztebl.2014.0010b

Prof. Dr. med. Klaus Dalhoff
Medizinische Klinik III – Pneumologie/Infektiologie, Lübeck
klaus.dalhoff@uk-sh.de

Prof. Dr. med. Santiago Ewig
Thoraxzentrum Ruhrgebiet, Bochum

Conflict of interest statement
Professor Dalhoff has had travel and accommodation costs reimbursed and has received fees for the preparation of scientific educational presentations from Astra- Zeneca, Bayer Vital, Novartis, Pfizer, and MSD. He has received third-party funding for his study center from Cubist, Cigma, Johnson & Johnson, and Cerexan. He has received funding from Bayer Vital for a research project initiated by himself.

Professor Ewig declares that no conflict of interest exists.

1.
Dalhoff K, Abele-Horn M, Andreas S, et al.: Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie. S-3 Leitlinie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e.V., der Deutschen Gesellschaft für Infektiologie e.V., der Deutschen Gesellschaft für Hygiene und Mikrobiologie e.V., der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. und der Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. Pneumologie 2012;
707–65.
2.
Giannella M, Rodriguez-Sanchez B, Roa PL, et al.: Should lower respiratory tract secretions from intensive care patients be systematically screened for influenza virus during the influenza season? Crit Care 2012; 16: R104. MEDLINE PubMed Central
3.
Schaberg T, Bauer T, Dalhoff K, et al.: Management der neuen Influenza A/H1N1-Virus-Pandemie im Krankenhaus: Eine Stellungnahme der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin. Pneumologie 2009; 63: 417–25. CrossRef MEDLINE
4.
Dalhoff K, Ewig S: Clinical Practice Guideline: Adult patients with nosocomial pneumonia—epidemiology, diagnosis and treatment. Dtsch Arztebl Int 2013; 110(38): 634–40. VOLLTEXT
1.Dalhoff K, Abele-Horn M, Andreas S, et al.: Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie. S-3 Leitlinie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e.V., der Deutschen Gesellschaft für Infektiologie e.V., der Deutschen Gesellschaft für Hygiene und Mikrobiologie e.V., der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. und der Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. Pneumologie 2012;
707–65.
2.Giannella M, Rodriguez-Sanchez B, Roa PL, et al.: Should lower respiratory tract secretions from intensive care patients be systematically screened for influenza virus during the influenza season? Crit Care 2012; 16: R104. MEDLINE PubMed Central
3.Schaberg T, Bauer T, Dalhoff K, et al.: Management der neuen Influenza A/H1N1-Virus-Pandemie im Krankenhaus: Eine Stellungnahme der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin. Pneumologie 2009; 63: 417–25. CrossRef MEDLINE
4.Dalhoff K, Ewig S: Clinical Practice Guideline: Adult patients with nosocomial pneumonia—epidemiology, diagnosis and treatment. Dtsch Arztebl Int 2013; 110(38): 634–40. VOLLTEXT

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