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Perioperative Antibiotikaprophylaxe bei Eingriffen mit der Herz-Lungen-Maschine

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Empfehlungen zum Einsatz und zur Verwendung der Herz-Lungen-Maschine

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4.3 Zusammenfassung

Die perioperative Antibiotikaprophylaxe bei Operationen am offenen Herzen gehört zu den gesicherten Maßnahmen, vornehmlich postoperative Wundinfektionen zu vermeiden. Es ist nicht ihre Aufgabe, andere nosokomiale Infektionen, z. B. Pneumonien und Harnwegsinfektionen, zu verhüten. Das ausgewählte Antibiotikum wird parenteral innerhalb der ersten Stunde vor Operationsbeginn verabreicht und bis zu 24 h, maximal jedoch höchstens 72 h postoperativ angewendet. Zu den bewährten Wirkstoffen zählen die einander gleichwertigen Erst- und Zweitgenerationszephalosporine (Cefazolin und Cefuroxim). Alternativpräparate sind Clindamycin und Glykopeptidantibiotika (Vancomycin, Teicoplanin). Ihr Einsatz bleibt jedoch besonderen Situationen (z.B. Penizillin-/Zephalosporinallergie oder nachweisliche Kolonisation des Patienten mit einem multiresistenten Staphylococcus-aureus-Stamm) vorbehalten. Ein breiter Einsatz der Glykopeptidantibiotika verbietet sich auch weiterhin trotz einer deutlichen Zunahme von oxacillinresistenten Staphylococcus-aureus-Stämmen in zahlreichen chirurgischen Herzzentren wegen der begründeten Gefahr, gegen diese Wirkstoffklasse resistente Enterokokken und Staphylokokken zu selektionieren. Zudem haben sich weder Clindamycin noch Vancomycin bzw. Teicoplanin gegenüber den älteren Zephalosporinen in der perioperativen Antibiotikaprophylaxe als überlegen erwiesen. Sie verhindern nicht mehr postoperative Wundinfektionen als diese Zephalosporinantibiotika.

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  1. Zentrum für Medizinische Mikrobiologie und Virologie Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf

    Dr. med. L. Thomas

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  1. Klinik für Thorax- und Kardiovaskuläre Chirurgie, Universitäts-Klinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstrasse 5, 40225, Düsseldorf

    Peter Feindt

  2. Zentrum für Herzchirurgie Erlangen-Nürnberg, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen

    Frank Harig  & Michael Weyand  & 

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Thomas, L. (2006). Perioperative Antibiotikaprophylaxe bei Eingriffen mit der Herz-Lungen-Maschine. In: Feindt, P., Harig, F., Weyand, M. (eds) Empfehlungen zum Einsatz und zur Verwendung der Herz-Lungen-Maschine. Steinkopff. https://doi.org/10.1007/3-7985-1646-4_5

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