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Nosokomiale Infektionen

Herausforderung MRSA und CDAD

Nosocomial infections: MRSA und CDAD as a challenge

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Zusammenfassung

Inadäquat intensiver Antibiotikagebrauch und unzureichende Hygiene- und Präventionsmaßnahmen sind für Auftreten und Verbreitung von methicillinresistenten Staphylococcus aureus (MRSA) und Clostridium difficile, dem wichtigsten Erreger der antibiotikaassoziierten Diarrhö und Kolitis, verantwortlich. Infektionen durch beide Erreger sind mit erheblicher Morbidität, vermehrter Sterblichkeit und enormem Ressourcenverbrauch verbunden. Auch in Deutschland wird ein Anstieg der Häufigkeit solcher Infektionen beobachtet – eine Herausforderung für alle klinisch tätigen Ärzte, für Krankenhaushygienepersonal, Qualitätsmanagement und Krankenhausleitung. Kritischer Antibiotikagebrauch, v. a. hinsichtlich moderner Fluorchinolone und Cephalosporine, ist eine wichtige Komponente der Prävention beider Komplikationen. Weitere zentrale Maßnahmen sind Minimierung der Erregerübertragung durch Ärzte und Pflegepersonal (v. a. durch adäquate Händehygiene), gezielte Patientenisolierung sowie spezifische Früherkennung (MRSA-Screening) und MRSA-Dekolonisierungsbehandlung. Isolierungsmaßnahmen dürfen nicht zu einer schlechteren Behandlungsqualität führen. Die Behandlungsergebnisse haben sich bei beiden Infektionen durch neue antimikrobielle Substanzen bisher nur unwesentlich verbessern lassen. Eine gute Verzahnung von ambulantem und stationärem Sektor ist besonders auch für die Kontrolle der Resistenzproblematik essenziell, beginnend mit einem offenen, transparenten Umgang.

Abstract

Inadequate antibiotic prescribing and poor adherence to infection control guidelines are the main reasons for the development and spread of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (CD), the most important cause of antibiotic-associated diarrhoea (AD) and colitis. Both CDAD and MRSA infection are associated with significant morbidity, excess mortality and substantial consumption of resources. Increases in the incidence of both infections have been observed in Germany and represent a challenge to clinicians, infection control practitioners, quality management teams und hospital administration. Prudent use of antibiotics, in particular critical prescribing of fluoroquinolones and cephalosporins, is an important component in programmes aiming at an effective prevention of MRSA and CDAD. Other similarly important components are minimization of pathogen transmission between patients and healthcare personnel by isolation and contact precautions, early detection of MRSA carriers and MRSA decolonization treatment. It must be ascertained that patients nursed in isolation rooms receive medical care of similar high quality as all other patients. Over the last years, there has been no major breakthrough in therapy and outcomes in both CDAD and MRSA infection. Close collaboration between hospitals, nursing homes and primary care institutions will be critical for better control of MRSA and CDAD.

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Interessenkonflikte

Die Autoren weisen auf folgende Beziehungen hin:

Professor Kern hat Aufwandsentschädigungen für die Planung, Ausführung oder Teilnahme an klinischen Studien und Honorare für die Teilnahme an Beratergremien oder Vorträge von folgenden Firmen erhalten: Bayer HealthCare, SanofiAventis, Pfizer, Wyeth, Novartis.

Professor Dettenkofer hat Vortragshonorare von folgenden Firmen erhalten: BBraun, Covidien, Gilead, Mölnlycke, Pfizer.

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  1. Medizinische Klinik/Infektiologie, Klinikum der Albert-Ludwigs-Universität, Hugstetter Straße 55, 79106, Freiburg, Deutschland

    W.V. Kern & M. Dettenkofer

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  2. M. Dettenkofer
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Correspondence to W.V. Kern.

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Kern, W., Dettenkofer, M. Nosokomiale Infektionen. Internist 50, 691–705 (2009). https://doi.org/10.1007/s00108-009-2389-8

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