Trauma und Berufskrankheit

, Volume 9, Issue 3, pp 191–195 | Cite as

Therapie nosokomialer Infektionen in der chirurgischen Intensivmedizin

Leitthema
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Zusammenfassung

Der Zeitpunkt, zu dem mit einer adäquaten Antibiotikatherapie begonnen wird, entscheidet über die Prognose von Patienten mit schweren nosokomialen Infektionen. Adäquat bedeutet in diesem Zusammenhang, dass das ausgewählte Antibiotikum klinisch wirksam gegen den entsprechenden Erreger ist und in einer ausreichend hohen Dosierung über den optimalen Zeitraum verabreicht wird. Während dieser Umstand eine liberale Verordnung von Antibiotika erfordert, zeigen klinische Daten, dass der exzessive Gebrauch von Breitspektrumantibiotika mit einer Zunahme von multiresistenten Erregern einhergeht. In Anbetracht dieses Konflikts soll der folgende Artikel Strategien für den Einsatz von Antibiotika in der Intensivmedizin aufzeigen. Besondere Beachtung finden die beatmungsassoziierte Pneumonie sowie das wachsende Problem multiresistenter Erreger. Die Kenntnis der lokalen Resistenzsituation, konsequentes Deeskalieren der empirischen Therapie, so bald Ergebnisse der mikrobiologischen Diagnostik vorliegen, und eine evidenzbasierte Begrenzung der Therapiedauer helfen dem Intensivmediziner, auch ohne übermäßigen Einsatz von Breitspektrumantibiotika eine adäquate Therapie zu gewährleisten.

Schlüsselwörter

Infektionen Antibiotika Intensivmedizin Deeskalation Beatmungsassoziierte Pneumonie 

Treatment of nosocomial infections in surgical critical care

Abstract

The timing of appropriate antibiotic therapy determines the prognosis of patients with severe nosocomial infections. In this context, “appropriate” means that the agent selected is effective against the pathogen and is used at the right dose for an adequately long course. While this calls for liberal prescribing policies for antibiotics, clinical data suggest that excessive use of broad-spectrum antibiotics leads to the emergence of multi-drug-resistant pathogens. The present article faces up to this dilemma, outlining strategies for antibiotic use in intensive care medicine, with special reference to ventilator-associated pneumonia and the growing problem of multi-drug-resistant pathogens. The intensivist can be helped to achieve an appropriate initial therapy without overuse of antibiotics by a thorough understanding of the local patterns of antibiotic resistance, consistent de-escalation of empiric therapy as soon as the results of microbiological diagnostic investigations are available and evidence-based limitation of the duration of therapy.

Keywords

Infections Antibiotics Intensive care De-escalation Ventilator-associated pneumonia 
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Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Zentrum für Chirurgie des Bewegungsapparates, Klinik für OrthopädieUniversitätsklinikum Schleswig-Holstein, Campus LübeckLübeckDeutschland
  2. 2.Chirurgische Klinik und Poliklinik, BG-Universitätsklinik BergmannsheilRuhr-Universität BochumBochumDeutschland

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