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Perioperative Antibiotikaprophylaxe bei Haut- und Weichteileingriffen

Antibiotic prophylaxis in dermatologic and soft tissue surgery

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Zusammenfassung

Im stationären Bereich werden in Deutschland jährlich über eine halbe Million dermatochirurgische Eingriffe vorgenommen, dazu kommt eine nicht genau bekannte Zahl operativer dermatochirurgischer Operationen im niedergelassenen Bereich. Trotz dieser hohen Zahlen werden in den aktuellen deutschsprachigen Leitlinien des Paul-Ehrlich-Instituts und der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften zur Durchführung der perioperativen Antibiotikaprophylaxe die Spezifika dermatochirurgischer Eingriffe im Gegensatz zu anderen, beispielsweise gynäkologischen, allgemein- und viszeralchirurgischen Eingriffen nicht explizit aufgezeigt. In der Literatur finden sich deutliche Hinweise, dass in der gegenwärtigen Praxis Unsicherheiten zur Indikation einer perioperativen Antibiotikaprophylaxe bestehen und letztendlich zu einer zu weit gefassten Indikationsstellung führen. Angesichts der bei weltweit ansteigenden Resistenzraten bestehenden Notwendigkeit zum rationalen Antibiotikaeinsatz und den individualmedizinischen Risiken, die ein Antibiotikaeinsatz bietet, werden in der folgenden Arbeit die Indikationen zur perioperativen Antibiotikaprophylaxe in der Dermatochirurgie kritisch diskutiert.

Abstract

In Germany, over half a million operations are done in dermatologic surgery in a hospital setting every year, as well as a less well quantified number of procedures in private offices. In spite of this large number, specific guidelines concerning the use of perioperative antibiotics in dermatologic surgery are sparse. In contrast to procedures in general, visceral or gynecological surgery, general guidelines on perioperative antibiotics issued by the Paul-Ehrlich Institutes and the AWMF do not specifically consider dermatologic operations. Several surveys indicate that familiarity with current recommendations on perioperative antibiotics is suboptimal and resulted in a considerable overuse of perioperative antibiotics in dermatologic surgery. Given the increasing antimicrobial resistance among important pathogens and the inherent risks of antibiotic administration, the decision for the use of prophylactic antibiotics should be based on the individual risk profile of the patient and of the surgical procedure. In the following, we will critically discuss the evidence for perioperative antibiotics in dermatologic surgery.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Schulze, M. Napp und S. Maier geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemeine Chirurgie, Visceral-, Thorax- und Gefäßchirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland

    T. Schulze

  2. Klinik und Poliklinik für Chirurgie, Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Deutschland

    M. Napp

  3. Klinik für Allgemein-, Viszeral-, Thorax und Gefäßchirurgie, Kliniken Ostallgäu-Kaufbeuren, Klinikum Kaufbeuren, Kaufbeuren, Deutschland

    S. Maier

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  1. T. Schulze
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  3. S. Maier
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Correspondence to T. Schulze.

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Schulze, T., Napp, M. & Maier, S. Perioperative Antibiotikaprophylaxe bei Haut- und Weichteileingriffen. Hautarzt 65, 32–38 (2014). https://doi.org/10.1007/s00105-013-2637-7

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