Zusammenfassung
Sepsis ist eine komplexe systemische Entzündungsreaktion in Folge einer Infektion und muss als ein medizinischer Notfall behandelt werden. Oft wird jedoch die Diagnose verzögert gestellt, obwohl gerade die schnelle zielgerichtete Kreislauftherapie und die Therapie mit Antibiotika innerhalb der ersten Stunden die Letalität deutlich senken kann. Im vorliegenden Beitrag werden die wesentlichen Punkte zur Pathophysiologie, Diagnose und Therapie zusammengefasst.
Abstract
Sepsis is a complex systemic inflammatory reaction in response to an infection and must be treated as an emergency. The diagnosis of sepsis is often delayed even though early goal-directed resuscitation and therapy with antibiotics within the first hours can reduce sepsis-related mortality. This article presents the most important points concerning the pathophysiology, diagnosis and therapy of sepsis.
Literatur
(o A) (2010) International Organizations Declare Sepsis a Medical Emergency. Issued by an expert panel representing 20 adult and pediatric intensive care societies, October 4th 2010. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3022986/
Hall MJ, Wiliams SN, DeFrances CJ et al (2011) Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS Data Brief No. 62. http://www.cdc.gov/nchs/data/databriefs/db62.pdf
Brun-Buisson C, Meshaka P, Pinton P et al (2004) EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med 30:580–588
Engel C, Brunkhorst FM, Bone HG et al (2007) Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med 33:606–618
Kissoon N, Carcillo JA, Espinosa V et al (2011) World Federation of Pediatric Intensive Care and Critical Care Societies: global sepsis initiative. Pediatr Crit Care Med 12:494–503
Hagel S, Brunkhorst F (2011) Sepsis. Intensivmed 48:57–73
Angus DC (2010) The lingering consequences of sepsis: a hidden public health disaster? JAMA 304:1833–1834
Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International sepsis definitions conference. Crit Care Med 31:1250–1256
Vincent JL (1997) Dear SIRS, I’m sorry to say that I don’t like you. Crit Care Med 25:372
Tracey KJ (2002) The inflammatory reflex. Nature 420:853–859
Lemaitre B, Nicolas E, Michaut L et al (1996) The dorsoventral regulatory gene cassette spätzle/Toll/cactus controls the potent antifungal response in Drosophila adults. Cell 86:973–983
Calvano SE, Xiao W, Richards DR et al (2005) A network-based analysis of systemic inflammation in humans. Nature 437:1032–1037
Kumar H, Kawai T, Akira S (2009) Toll-like receptors and innate immunity. Biochem Biophys Res Commun 388:621–625
Der Poll van T, Opal SM (2008) Host-pathogen interactions in sepsis. Lancet Infect Dis 8:32–43
Eltzschig HK, Carmeliet P (2011) Hypoxia and Inflammation. N Engl J Med 364:656–665
Edwards AM, Massey RC (2011) How does Staphylococcus aureus escape the bloodstream? Trends Microbiol 19:184–190
Waters CM, Bassler BL (2005) Quorum sensing: cell-to-cell communication in bacteria. Annu Rev Cell Dev Biol 21:319–346
Riedemann NC, Guo RF, Ward PA (2003) Novel strategies for the treatment of sepsis. Nat Med 9:517–524
Ehrnthaller C, Ignatius A, Gebhard F (2011) New insights of an old defense system: structure, function, and clinical relevance of the complement system. Mol Med 17:317–329
Czermak BJ, Sarma V, Pierson CL et al (1999) Protective effects of C5a blockade in sepsis. Nat Med 5:788–792
Levi M, Opal SM (2006) Coagulation abnormalities in critically ill patients. Crit Care 10:222
Reinhart K, Bauer M, Riedemann NC et al (2012) New approaches to sepsis: molecular diagnostics and biomarkers. Clin Microbiol Rev 25:609–634
Schuetz P, Chiappa V, Briel M et al (2011) Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med 171:1322–1331
Nobre V, Harbarth S, Graf JD et al (2008) Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 177:498–505
Brunkhorst FM, Gastmeier P, Kern W et al (2010) Prävention und Nachsorge der Sepsis. Internist (Berl) 51:925–932
Reimer LG, Wilson ML, Weinstein MP (1997) Update on detection of bacteremia and fungemia. Clin Microbiol Rev 10:444–465
Pletz MW, Wellinghausen N, Welte T (2011) Will polymerase chain reaction (PCR)-based diagnostics improve outcome in septic patients? A clinical view. Intensive Care Med 37:1069–1076
Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596
Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377
Reinhart K, Perner A, Sprung CL et al (2012) Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensive Care Med 38:368–383
Brunkhorst FM, Reinhart K (2009) Diagnose und kausale Therapie der Sepsis. Internist 50:810–816
Danksaguung
Diese Arbeit wurde durch das Bundesministerium für Bildung und Forschung (BMBF) gefördert (Förderkennzeichen 01EO1002).
Interessenkonflikt
Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stehr, S., Woest, I., Hartog, C. et al. Sepsis. Internist 54, 63–74 (2013). https://doi.org/10.1007/s00108-012-3192-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00108-012-3192-5