Zusammenfassung
In den letzten Jahren ist es zu einem starken Anstieg der gramnegativen multiresistenten Erreger (MRE) gekommen. Die meisten Patienten bringen diese MRE bereits bei der Aufnahme in das Krankenhaus mit. Besondere Aufmerksamkeit muss auf die Carbapenemase-bildenden Enterobakterien („carbapenemase-producing“ Enterobacteriaceae, CPE) gelegt werden, die insbesondere bei thoraxchirurgischen Patienten aus Hochrisikoländern häufig anzutreffen sind (z. B. Griechenland, Naher Osten, Golfstaaten). Bei Infektionen mit CPE sind die therapeutischen Möglichkeiten äußerst begrenzt. Das Ziel ist es deshalb, Patienten mit diesen Erregern möglichst schnell zu erkennen und von vornherein die Verbreitung in der eigenen Abteilung zu verhindern. Sofern es bereits zu Transmissionen gekommen ist, muss durch ein gründliches rektales Screening aller möglichen Kontaktpatienten und aller durch dasselbe Personal gepflegten Patienten sicher identifiziert werden, welche Patienten kolonisiert sind, um sie entsprechend zu kohortieren.
Abstrack
An enormous increase in Gram negative multiresistant organisms has been observed during recent years. Most patients are already carrying these pathogens on admission to hospital. The attention should in particular focus on patients with carbapenemase-producing Enterobacteriaceae (CPE), which have often been identified in cardiothoracic patients from high risk countries (e.g. Greece, Near East and the Gulf States). The therapeutic options in the case of infections with CPE are very limited. The aim is therefore to identify patients with these pathogens early and to prevent transmission to other patients from the very beginning. If transmission has already occurred a strict rectal screening of all contact patients and all patients cared for by the same personnel is necessary to identify all infected patients and to cohort them.
Literatur
Grave K, Torren-Edo J, Mackay D (2010) Comparison of the sales of veterinary antibacterial agents between 10 European countries. J Antimicrob Chemother 65:2037–2040
Leverstein-van Hall M, Dierikx C, Cohen S et al (2011) Dutch patients, retail chicken meat and poultry share the same ESBL genes, plasmids and strains. Clin Microbiol Infect 17:873–880
Overdevest I, Willemsen I, Rijnsburger M et al (2011) Extended-spectrum beta-lactamase genes of Escherichia coli in chicken meat and humans, The Netherlands. Emerg Infect Dis 17:1216–1222
Kola A, Kohler C, Pfeifer Y et al (2012) High prevalence of extended-spectrum β-lactamase 1 (ESBL)–producing Enterobacteriaceae in organic and conventional retail chicken meat, Germany. J Antimicrob Chemother 67:2631–2634
Alsterlund R, Axelsson C, Olsson-Liljequist B (2012) Long-term carriage of extended-spectrum beta-lactamase producing Escherichia coli. Scand J Infect Dis 44:51–54
Hilty M, Betsch B, Bögli-Stuber K et al (2012) Transmission dynamics of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in the tertiary care hospital and the household setting. Clin Infect Dis 55:967–975
Cosgrove S, Sakoulas G, Perencevich E et al (2003) Comparison of mortality associated with methicillin resistant and methicillin-susceptible Staphylococus aureus bacteremia: a meta-analysis. Clin Infect Dis 36:53–59
De Kraker M, Wolkewitz M, Davey P et al (2011) Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother 55:1598–1605
De Kraker M, Wolkewitz M, Davey P et al (2011) Burden of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins. J Antimicrob Chemother 66:398–407
Rottier W, Ammerlaan H, Bonten M (2012) Effects of confounders and intermediates on the association of bacteraemia caused by extended-spectrum β-lactamase-producing Enterobacteriaceae and patient outcome: a meta-analysis. J Antimicrob Chemother 67:1311–1320
Potron A, Kalpoe J, Poirel L, Nordmann P (2011) European dissemination of a single OXA-48-producing Klebsiella pneumoniae clone. Clin Microbiol Infect 17:E24–26
Ben-David D, Kordevani R, Keller N et al (2012) Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect 18:54–60
Centers for Disease Control and Prevention (2012) Guidance for carbapenem-resistant Enterobacteriaceae. http://www.cdc.gov
Lepelletier D, Andremont A, Grandbastien B; The National Working Group (2011) Risk of highly resistant bacteria importation from repatriates and travelers hospitalized in foreign countries: about the French recommendations to limit their spread. J Travel Med 18:344–351
Anonym (2012) Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 55:1311–1354
Morgan D, Rogawski E, Thom K et al (2012) Transfer of multidrug resistant bacteria to healthcare worker’s gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 40:1045–1051
Goddard S, Muller M (2012) The efficacy of infection control interventions in reducing the incidence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the nonoutbreak setting: a systematic review. Am J Infect Control 39:599–601
Harbarth S, Samore M, Lichtenberg D, Carmeli Y (2000) Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 101:2916–2921
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Gastmeier, P. Problemkeime. Z Herz- Thorax- Gefäßchir 27, 49–53 (2013). https://doi.org/10.1007/s00398-012-0975-x
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DOI: https://doi.org/10.1007/s00398-012-0975-x