Zusammenfassung
Die zunehmende Inzidenz von humanpathogenen Mikroorganismen mit ausgeprägten Resistenzeigenschaften bis hin zur Unempfindlichkeit gegenüber selbst breit wirksamen Reserveantibiotika stellt die Verantwortlichen in infektions- und krankenhaushygienischen klinischen Bereichen für lebensbedrohlich Erkrankte, v. a. Intensivstationen oder Transplantationseinheiten, vor schier unlösbare Probleme. Das Management von grampositiven Erregern, wie MRSA und VRE, auf der Basis von evidenzbasierten Empfehlungen hat inzwischen zu einer messbaren Abnahme der Infektionsinzidenz und -dichte geführt, und bei einer Therapieindikation steht sogar eine Auswahl an verlässlich wirksamen Arzneimitteln zur Verfügung. Im Fall von multiresistenten gramnegativen Erregern (MRGN) bleibt zunehmend nur der Einsatz unklar definierter Therapieregime mit älteren Wirkstoffen, meist unter dem Risiko relevanter Nebenwirkungen und Organtoxizitäten. In der vergleichenden Betrachtung von MRSA und MRGN werden die Ähnlichkeiten und Besonderheiten im krankenhaushygienischen Management von MRGN vorgestellt.
Abstract
The incidence of human-pathogenic microorganisms with resistance or even complete insensitivity to broad-spectrum antibiotics is increasing. This poses a serious challenge to infection control in hospitals and to hygiene strategies in clinical areas with critically ill patients, particularly intensive care or transplant units. These microorganisms create problems that are seemingly impossible to solve at present. The management of gram-positive pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) has been facilitated by evidence-based recommendations resulting in a measurable decrease in the incidence of infection and, where treatment is concerned, in a selection of reliably effective drugs for clinicians. However, in the more frequent cases of multiresistant gram-negative (MRGN) pathogens, the only option is the use of poorly defined regimens with older drugs, which carry the risk of serious side effects and organ toxicities. This article presents a comparative analysis of hospital hygiene management for MRSA and MRGN pathogens, pointing out both similarities and features which are unique to MRGN pathogens.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehung/en hin: R.R. keine; K.S. Care Fusion, Germany; Rudolf-Schulte-Stiftung, Deutschland; Astella, Germany.
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Schröppel, K., Riessen, R. Multiresistente gramnegative Bakterien . Med Klin Intensivmed Notfmed 108, 107–112 (2013). https://doi.org/10.1007/s00063-012-0160-8
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DOI: https://doi.org/10.1007/s00063-012-0160-8