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Prokalzitoninbasierte Algorithmen

Steuerung der Antibiotikatherapie bei kritisch kranken Patienten

Procalcitonin-based algorithm

Management of antibiotic therapy in critically ill patients

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Zusammenfassung

Die Sepsis ist nicht nur eines der kostenintensivsten Krankheitsbilder in der Intensivmedizin, sie ist auch mit einer hohen Morbidität und Mortalität vergesellschaftet. Der zügige Beginn einer Antibiotikatherapie kann nachweislich die Mortalität senken. Die Resistenzentwicklung der infizierenden Keimspezies gibt Anlass, Indikation und Applikation zur Verfügung stehender Antibiotika zu überdenken. Gerade der Einsatz hochpotenter Substanzen im Intensivbereich bedarf der adäquaten Indikationsstellung und Therapiedauer. Bislang existierte kein laborchemischer Parameter, der spezifisch eine bakterielle Infektion von viralen oder nichtinfektiösen Entzündungsreaktionen anzuzeigen vermochte. Mit Prokalzitonin (PCT) scheint nun ein solcher Parameter verfügbar zu sein. Prokalzitoninbestimmungen können eine kürzere Antibiotikatherapiedauer mit vorteilhaften Auswirkungen auf die Antibiotikatherapiekosten bewirken, ohne nachteilige Auswirkungen auf das „outcome“ des Patienen zu haben.

Abstract

Sepsis is one of the most cost-intensive conditions of critically ill patients in intensive care medicine. Furthermore, sepsis is known to be the leading cause of morbidity and of mortality in intensive care patients. Early initiation of antibiotic therapy can significantly reduce mortality. The development of resistance of bacterial species against antibiotics is a compelling issue to reconsider indications and administration of antibiotic treatment. Adequate indications and duration of therapy are particularly important for the use of highly potent substances in the intensive care setting. Until recently no laboratory marker has been available to distinguish bacterial infections from viral or non-infectious inflammatory responses. However, procalcitonin (PCT) appears to be the first among a large array of inflammatory markers that offers this possibility. Regular procalcitonin measurements can significantly shorten the length of antibiotic therapy, show positive influence on antibiotic costs and have no adverse affects on patient outcome.

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Interessenkonflikt

Herr Priv.-Doz. Dr. Schroeder gibt an, dass er für die Brahms AG Vorträge gehalten hat. Herr Dr. Hochreiter gibt an, dass keine Interessenkonflikte bestehen.

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  1. Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    M. Hochreiter

  2. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Krankenhaus Düren gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Düren, Deutschland

    S. Schroeder

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Hochreiter, M., Schroeder, S. Prokalzitoninbasierte Algorithmen. Anaesthesist 60, 661–673 (2011). https://doi.org/10.1007/s00101-011-1884-1

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