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Management der Sepsis: Erstantibiose bereits im Rettungs- und Notarztdienst

Pro und Kontra
  • S. CasuEmail author
  • D. Häske
  • F. Herbstreit
  • P.-M. Rath
Leitthema
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Zusammenfassung

Die Sepsis ist eine häufige und gefährliche Erkrankung, an der die Patienten oft versterben. Der Beitrag stellt die kontroverse Meinung (Pro und Kontra) zweier Autorengruppen hinsichtlich einer frühzeitigen Erstantibiose in der Präklinik vor. Die „Pro-Gruppe“ vertritt die Ansicht, dass die Patienten bereits von einer frühzeitigen Diagnose und anschließender Erstantibiose im Rettungs- und Notarztdienst profitieren. Da keine Hinweise für schädliche Folgen einer solchen Therapie existieren, ist es aus Sicht der Autoren nur schwer nachvollziehbar, weshalb eine offensichtlich lebensrettende Gabe eines Antibiotikums nicht bereits präklinisch erfolgen sollte. Die „Kontra-Gruppe“ sieht den Nutzen einer präklinischen Antibiotikatherapie für den ohnehin im Rettungsdienst seltenen und schwer zu diagnostizierenden septischen Schock nicht klar belegt. Außerdem werden neben logistischen Schwierigkeiten negative Auswirkungen hinsichtlich Diagnostik und Resistenzentwicklung befürchtet, sodass eine präklinische Antibiotikatherapie bei den hierzulande kurzen Transportzeiten überflüssig scheint.

Schlüsselwörter

Antibiotikatherapie Notfallmedizin Rettungssanitäter Präklinische Phase Resistenz 

Management of sepsis: initial antibiotic treatment already by the emergency medical personnel

Pro and contra

Abstract

Sepsis is a common and dangerous disease that is often lethal. In this paper, the controversial opinion (pros and cons) of two groups of authors regarding early initial antibiotic treatment in the preclinical setting is presented. The “pro group” is of the opinion that patients already benefit from early diagnosis and subsequent initial antibiotic treatment by the emergency medical personnel. Since there is no evidence for harmful consequences of such a therapy, the authors find it difficult to understand why an obviously life-saving administration of an antibiotic should not already be carried out by emergency medical personnel. The authors arguing against the prehospital application of antibiotics („contra-position“) stress a lack of evidence supporting antibiotic use in the EMS (emergency medical services) setting. Septic shock is difficult to diagnose for and rarely treated by EMS personnel. Besides presenting logistical challenges, the authors fear a negative impact on microbiological diagnostics and antibiotic resistance. Given the short prehospital times in Germany, prehospital antibiotic therapy seems superfluous.

Keywords

Antibiotic treatment Emergency Preclinical setting Paramedic Resistance 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Casu, D. Häske, F. Herbstreit und P.-M. Rath geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Dorsett M, Kroll M, Smith CS et al (2017) qSOFA has poor sensitivity for prehospital identification of severe sepsis and septic shock. Prehosp Emerg Care 21(4):489–497CrossRefGoogle Scholar
  2. 2.
    Bayer O, Schwarzkopf D, Stumme C et al (2015) An early warning scoring system to identify septic patients in the prehospital setting: the PRESEP score. Acad Emerg Med 22(7):868–871CrossRefGoogle Scholar
  3. 3.
    Jouffroy R, Saade A, Ellouze S et al (2018) Prehospital triage of septic patients at the SAMU regulation: comparison of qSOFA, MRST, MEWS and PRESEP scores. Am J Emerg Med 36(5):820–824CrossRefGoogle Scholar
  4. 4.
    Smyth MA, Brace-McDonnell SJ, Perkins GD (2016) Identification of adults with sepsis in the prehospital environment: a systemic review. BMJ Open 6(8):e11218CrossRefGoogle Scholar
  5. 5.
    Femling J, Weiss S, Hauswald E et al (2017) EMS patients and walk-in patients presenting with severe sepsis: differences in management and outcome. South Med J 107(12):751–756CrossRefGoogle Scholar
  6. 6.
    Groenewoudt M, Roest AA, Leijten FM et al (2014) Septic patients arriving with emergency medical services: a seriosly ill population. Eur J Emerg Med 21(5):330–335CrossRefGoogle Scholar
  7. 7.
    Casu S, Blau J, Schempf B et al (2018) If you don’t take a temperature, you can’t find a fever. Awareness in out-of-hospital vital signs in cases of suspected sepsis. Notfall Rettungsmed.  https://doi.org/10.1007/s10049-018-0526-4 CrossRefGoogle Scholar
  8. 8.
    Seymour CW, Carlbom D, Engelberg RA et al (2012) Understanding of sepsis among emergency medical services: a survey study. J Emerg Med 42(6):666–699CrossRefGoogle Scholar
  9. 9.
    Van der Wekken LC, Alam N, Holleman F et al (2016) Epidemiology of sepsis and its recognition by emergency medical services personnel in the Netherlands. Prehosp Emerg Care 20(1):90–96CrossRefGoogle Scholar
  10. 10.
    Peltan ID, Mitchell KH, Rudd KE et al (2018) Ann Am Thorac Soc.  https://doi.org/10.1513/AnnalsATS.201803-199OC CrossRefPubMedGoogle Scholar
  11. 11.
    Ferrer R, Martin-Loeches I, Phillips G et al (2015) Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 42:1749–1755CrossRefGoogle Scholar
  12. 12.
    Kumar A, Roberts D, Wood KE et al (2006) Crit Care Med 34:1589–1596CrossRefGoogle Scholar
  13. 13.
    Seymour CW, Kahn JM, Martin-Gill C et al (2017) Delays from first medical contact to antibiotic administration for sepsis. Crit Care Med 45(5):759–765CrossRefGoogle Scholar
  14. 14.
    Vincent JL, Mira JP, Antonelli M (2016) Sepsis: older and newer concepts. Lancet Respir Med 4:237–240CrossRefGoogle Scholar
  15. 15.
    Levy MM, Evans LE, Rhodes A (2018) The surviving sepsis campaign bundle: 2018 update. Intensive Care Med 44:925CrossRefGoogle Scholar
  16. 16.
    Seymour CW, Gesten F, Prescott HC et al (2017) Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 376(23):2235–2244CrossRefGoogle Scholar
  17. 17.
    Alam N, Oskam E, Stassen PM et al (2018) Prehospital antibiotics in the ambulance for sepsis: a multicenter, open label, randomized trial. Lancet Respir Med 6(1):40–50CrossRefGoogle Scholar
  18. 18.
    Casu S, Häske D (2016) Severe sepsis and septic shock in pre-hospital emergency medicine: survey results of medical directors of emergency medical services concerning antibiotics, blood cultures and algorithms. Intern Emerg Med 11(4):571–576CrossRefGoogle Scholar
  19. 19.
    Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S 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(6):1589–1596CrossRefGoogle Scholar
  20. 20.
    Ferrer R, Martín-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP et al (2014) Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 42(8):1749–1755CrossRefGoogle Scholar
  21. 21.
    Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS et al (2017) Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med 376(23):2235–2244CrossRefGoogle Scholar
  22. 22.
    Kaasch AJ, Rieg S, Kuetscher J, Brodt H‑R, Widmann T, Herrmann M et al (2013) Delay in the administration of appropriate antimicrobial therapy in Staphylococcus aureus bloodstream infection: a prospective multicenter hospital-based cohort study. Infection 41(5):979–985CrossRefGoogle Scholar
  23. 23.
    Sterling SA, Miller WR, Pryor J, Puskarich MA, Jones AE (2015) The impact of timing of antibiotics on outcomes in severe sepsis and septic shock: a systematic review and meta-analysis. Crit Care Med 43(9):1907–1915CrossRefGoogle Scholar
  24. 24.
    Smyth MA, Brace-McDonnell SJ, Perkins GD (2016) Identification of adults with sepsis in the prehospital environment: a systematic review. BMJ Open 6(8):e11218CrossRefGoogle Scholar
  25. 25.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315(8):801–810CrossRefGoogle Scholar
  26. 26.
    Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A et al (2016) Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315(8):762–774CrossRefGoogle Scholar
  27. 27.
    Alam N, Oskam E, Stassen PM, Exter PV, van de Ven PM, Haak HR et al (2018) Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Lancet Respir Med 6(1):40–50CrossRefGoogle Scholar
  28. 28.
    Scheer CS, Fuchs C, Gründling M, Vollmer M, Bast J, Bohnert JA et al (2018) Impact of antibiotic administration on blood culture positivity at the beginning of sepsis: a prospective clinical cohort study. Clin Microbiol Infect.  https://doi.org/10.1016/j.cmi.2018.05.016 CrossRefPubMedGoogle Scholar
  29. 29.
    Zaura E, Brandt BW, Teixeira de Mattos MJ, Buijs MJ, Caspers MPM, Rashid MU et al (2008) Same exposure but two radically different responses to antibiotics: Resilience of the salivary microbiome versus long-term microbial shifts in feces. Clin Infect Dis 46:1838–1843CrossRefGoogle Scholar
  30. 30.
    Khalil D, Hultin M, Rashid MU, Lund B (2016) Oral microflora and selection of resistance after a single dose of amoxicillin. Clin Microbiol Infect 22:949.e1–949.e4CrossRefGoogle Scholar
  31. 31.
    Carignan A, Allard C, Pe’pin J, Cossette B, Nault V, Valiquette L (2008) Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain. Clin Infect Dis 46:1838–1843CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Intensiv- und NotfallmedizinHelios Klinikum Salzgitter GmbHSalzgitterDeutschland
  2. 2.Medizinische FakultätEberhard Karls Universität TübingenTübingenDeutschland
  3. 3.Klinik für Anästhesiologie und IntensivmedizinUniversitätsklinikum EssenEssenDeutschland
  4. 4.Institut für Medizinische MikrobiologieUniversitätsklinikum EssenEssenDeutschland

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