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Diagnostische Marker und Effektivitätsbewertung in der antibakteriellen Therapie

Diagnostic markers and assessment of efficacy of antibacterial therapy

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Zusammenfassung

Unter dem Aspekt von Therapieeffektivität, Prognose und Resistenzentwicklung sind bei antiinfektiver Thereapie nachfolgende Themen von zentraler Bedeutung:

  • Festlegung der Behandlungsbedürftigkeit einer bakteriellen Infektion mit Antibiotika,

  • Wirksamkeit der kalkulierten Initialtherapie,

  • Beendigung der antimikrobiellen Therapie.

Diese Kardinalpunkte im Behandlungszyklus einer bakteriellen Infektion lassen sich v. a. durch klinische Einschätzung, Gewinnung von Materialien für die mikrobiologische Untersuchung (Blutkulturen, Urin, respiratorische Sekrete) und mehrzeitige Bestimmungen des Prokalzitonins (PCT) angehen. Grundsätzlich ist zwischen Atemwegsinfektionen und schweren systemischen Infektionen, wie Sepsis, in Bezug auf die Grenzwerte zu unterscheiden. Die PCT-Befunde sind immer im klinischen Kontext zu bewerten. Bei ihrer Interpretation muss darauf hingewiesen werden, dass neben bakteriellen Infektionen auch andere Erkrankung zu erhöhten PCT-Werten führen. Dazu gehören kalzitoninproduzierende Tumore, das medulläre C-Zell-Karzinom der Schilddrüse, das akute respiratorische Distress-Syndrom (ARDS) sowie Pilzinfektionen. Lokalisierte und abgekapselte Infektionen, wie z. B. Abszesse, Endokarditiden und Frühstadien einer bakteriellen Infektion, können niedrige PCT-Werte hervorrufen.

Abstract

In anti-infective therapy, there is a need for objective diagnostic markers to guide the appropriate selection and duration of antibacterial treatment. In the diagnosis and treatment of bacterial infections, three aspects must be considered:

  • the appropriateness of antibacterial therapy,

  • the initiation and evaluation of an effective initial therapy, and

  • termination of the antimicrobial treatment.

Repetitive monitoring of procalcitonin (PCT) has been proposed as such a marker in conjunction with the clinical presentation and microbiological sampling of blood, urine, and/or sputum. Different threshold values for PCT in pulmonary infections vs. severe systemic infections (e.g., sepsis) have been proposed. However, a single PCT determination is not sufficient, only consecutive measurements can give feedback of the appropriateness and success of the antibacterial therapy. Furthermore, it is important to realize that besides bacterial infection, other disease states can elevate PCT levels. Examples are calcitonin-producing tumors, medullary C-cell thyroid carcinoma, and acute respiratory distress syndrome (ARDS). PCT can also be elevated in fungal infections. On the other hand, localized and encapsulated infections (e.g., abscess, endocarditis and early stages of infections) can be associated with lowered PCT values.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K.-F. Bodmann hat für die Firma Thermo Fisher Scientific Vorträge gehalten.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinikum Barnim GmbH, Werner Forßmann Krankenhaus, Rudolf-Breitscheid-Str. 100, 16225, Eberswalde, Deutschland

    K.-F. Bodmann

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Bodmann, KF. Diagnostische Marker und Effektivitätsbewertung in der antibakteriellen Therapie. Med Klin Intensivmed Notfmed 109, 187–190 (2014). https://doi.org/10.1007/s00063-013-0312-5

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