Der Nephrologe

, Volume 4, Issue 3, pp 239–249 | Cite as

Infektionen nach Nierentransplantation

  • L.P. Kihm
  • V. Schwenger
  • M. Zeier
  • C. Sommerer
  • C. Morath
Leitthema
  • 158 Downloads

Zusammenfassung

Während sich das Transplantatüberleben in den vergangenen Dekaden deutlich verbessert hat, ist die Rate der Infektionen im Wesentlichen gleichgeblieben. Infektionen sind nach wie vor die zweithäufigste Todesursache nach Nierentransplantation. Die damit verbundenen Anforderungen an den behandelnden Nephrologen erfordern einerseits eine dezidierte Abklärung und Aufklärung des Patienten vor Transplantation, andererseits eine sorgfältige Überwachung nach erfolgreicher Transplantation. An prophylaktischen Maßnahmen steht im Vordergrund, schon vor Transplantation eine Risikostratifizierung zu erheben, potenzielle Infektionsherde zu identifizieren und zu sanieren, notwendige Impfungen durchzuführen und den Patienten bezüglich potenzieller Gefahren zu informieren. Nach Transplantation ist insbesondere in der initialen Phase eine engmaschige Überwachung des Patienten hinsichtlich Infektionen zu gewährleisten. Im Falle von Fieber oder Anstieg der Infektparameter (Leukozytose, Anstieg von C-reaktivem Protein) sollte frühzeitig eine intensive Abklärung erfolgen, der sich eine zielgerichtete antimikrobielle Therapie anschließt. Durch leitliniengerechte frühzeitige interdisziplinäre Diagnostik und Therapie lassen sich auch schwerwiegende, potenziell lebensbedrohliche Infektionen größtenteils gut beherrschen.

Schlüsselwörter

Transplantation Infektionen Risikostratifizierung Prophylaxe Antimikrobielle Therapie 

Infections following kidney transplantation

Abstract

Although transplantation survival has shown a clear improvement over the last decades, the infection rate has essentially remained the same. Infections are still the second most common cause of death after kidney transplantation. The associated demands on nephrologists necessitate resolute clarification and enlightenment of the patient before transplantation as well as detailed surveillance after successful transplantation. The main priority for prophylactic measures even before transplantation is to form a risk stratification to identify and remove potential foci of infection, to carry out the necessary vaccinations and to inform the patient of potential dangers. After transplantation a close surveillance of the patient with respect to infections must be ensured, especially in the initial phase. In the case of fever or increased parameters of infection, e.g. leucocytosis and increased C-reactive protein levels, an intensive clarification should be carried out as early as possible followed by a targeted antimicrobial therapy. Guideline-conform early interdisciplinary diagnosis and treatment allows successful management of the majority of severe, potentially life-threatening infections.

Keywords

Transplantation Infections Risk stratification Prophylaxis Antimicrobial therapy 

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • L.P. Kihm
    • 1
  • V. Schwenger
    • 1
  • M. Zeier
    • 1
  • C. Sommerer
    • 1
  • C. Morath
    • 1
  1. 1.Nierenzentrum HeidelbergHeidelbergDeutschland

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