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Die infektiöse Endokarditis bei Intensivpatienten

Infectious endocarditis in intensive care patients

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Zusammenfassung

Die infektiöse Endokarditis ist eine seltene Erkrankung mit hohem Mortalitätsrisiko. In den letzten Jahren haben epidemiologische Verschiebungen im Altersgefälle der betroffenen Patienten, das Auftreten neuer Risikofaktoren sowie die zunehmende Verwendung intravasaler prothetischer Materialien zu Veränderungen im klinischen Erscheinungsbild sowie in Diagnostik und Therapie der Endokarditis geführt.

Von herausragender Bedeutung ist eine frühzeitige Diagnosestellung. Die unspezifischen Symptome, aber auch das zunehmend häufigere Auftreten „nosokomialer“ Endokarditiden, oft bei schwerkranken Patienten auf Intensivstationen, fordern die diagnostische Kompetenz des behandelnden Arztes. Hierbei stehen diagnostische und therapeutische Algorithmen zur Verfügung, die von einer zügigen Diagnose zur adäquaten Therapie der Erkrankung leiten sollen. Es kann gerade auf der Intensivstation wichtig sein, zum richtigen Zeitpunkt die Indikation zu einer chirurgischen Sanierung der Infektion zu stellen.

Entsprechend den aktuellen Leitlinien wird in dieser Übersicht die gängige Praxis in der Diagnostik und Therapie der infektiösen Endokarditis dargestellt und für Intensivpatienten kommentiert.

Abstract

Infectious endocarditis is a rare disease with high mortality. Epidemiological changes in recent years, the emergence of new risk factors, and the increasing use of intravasal prosthetic materials has led to changes in not only the clinical appearance of this disease but also in its diagnosis and treatment.

Early diagnosis of infectious endocarditis is crucial. However, the often unspecific symptoms and the changes in its epidemiologic profile pose a challenge for the treating physician. This is especially true since the incidence of hospital-acquired, “nosocomial” cases of infectious endocarditis is increasing and often affects severely ill patients in intensive care units (ICU). There are diagnostic and therapeutic algorithms to guide the physician from an early diagnosis to an adequate treatment of the disease. In some critically ill patients, only surgery in combination with antimicrobial treatment may lead to complete eradication of the infectious disease.

This review aims to subsume the guidelines, paying special attention to aspects that are important for intensive care and emergency doctors.

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Abbreviations

AHA:

American Heart Association

BK:

Blutkultur

CT:

Computertomographie

ELISA:

„Enzyme-linked immunosorbent assay“

EPU:

Elektrophysiologische Untersuchung

ESC:

European Society of Cardiology

IE:

Infektiöse Endokarditis

ICD:

Implantierbarer Cardioverter-Defibrillator

LV:

Linksventrikulär bzw. linker Ventrikel

MIC:

“Minimum inhibitory concentration”; minimale Hemmkonzentration

MRSA:

Methicillinresistenter Staphylococcus aureus

MRT:

Magnetresonanztomographie

PCR:

“Polymerase chain reaction”, Polymerasekettenreaktion

PCT:

Prokalzitonin

PEEP:

Positiver endexspiratorischer Druck

PVIE:

“Prosthetic valve infectious endocarditis”, Klappenprothesenendokarditis

RV:

Rechtsventrikulär bzw. rechter Ventrikel

TTE:

Transthorakale Echokardiographie

TEE:

Transösophageal bzw. transösophageale Echokardiographie

VRE:

Vancomycinresistente Enterokokken

ZVK:

Zentraler Venenkatheter

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Reisekostenerstattung durch die Firmen Bayer, Lilly, Novartis, Boehringer Ingelheim.

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  1. Universitätsklinik und Poliklinik für Innere Medizin III (Kardiologie/Angiologie/Internistische Intensivmedizin/Geriatrie/Sportmedizin), Department für Innere Medizin, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle/Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland

    S. Dietz, H. Lemm, U. Raaz, K. Werdan & M. Buerke

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  1. S. Dietz
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Correspondence to S. Dietz.

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Dietz, S., Lemm, H., Raaz, U. et al. Die infektiöse Endokarditis bei Intensivpatienten. Med Klin Intensivmed Notfmed 107, 39–52 (2012). https://doi.org/10.1007/s00063-011-0006-9

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