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Bakterielle hepatobiliäre Infektionen

Erregerspektrum, antimikrobielle Resistenzentwicklung und aktuelle Therapiekonzepte

Bacterial hepatobiliary infections

Pathogen spectrum, antimicrobial resistance and current treatment concepts

  • Schwerpunkt: Infektiologische Probleme in der Gastroenterologie
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Aszendierende Cholangitiden und pyogene Leberabszesse sind akut fieberhaft verlaufende bakterielle hepatobiliäre Erkrankungen. Sie treten heutzutage häufig bei Patienten mit strukturellen Veränderungen des Gallenwegssystems auf und werden mithilfe der Kombination aus interventionellen Drainageverfahren und antimikrobieller Therapie behandelt. Während in der Vergangenheit gramnegative Enterobacterales als führende Ursache identifiziert wurden, haben Gallenwegsinterventionen und Antibiotikaexpositionen zur Zunahme von Enterokokkenspezies und Extended-spectrum-β-Lactamase(ESBL)-bildenden Enterobacterales beigetragen. Der behandelnde Internist muss bei der Wahl einer geeigneten empirischen Therapie neben pharmakokinetischen Aspekten und Schweregrad der Erkrankung auch lokale und individuelle Risikofaktoren für eine antimikrobielle Resistenz berücksichtigen, um die Wahrscheinlichkeit eines Therapieversagens zu reduzieren.

Abstract

Ascending cholangitis and pyogenic liver abscesses are acute febrile bacterial hepatobiliary diseases. Nowadays they frequently occur in patients with structural changes of the biliary system and are usually treated by a combination of interventional drainage procedures and antimicrobial therapy. While Gram-negative Enterobacterales were identified as major causes in the past, biliary tract interventions and antibiotic exposure have contributed to an increase in enterococcal species and extended spectrum beta-lactamase (ESBL)-producing Enterobacterales. When selecting an appropriate empirical treatment the treating internist must consider local and individual risk factors for antimicrobial resistance in addition to pharmacokinetic aspects and disease severity to reduce the likelihood of treatment failure.

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  1. Medizinische Klinik III, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    Tony Bruns

  2. Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland

    Andreas Stallmach

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Bruns, T., Stallmach, A. Bakterielle hepatobiliäre Infektionen. Internist 63, 349–366 (2022). https://doi.org/10.1007/s00108-022-01277-0

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