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Neues in der perioperativen antibiotischen Prophylaxe

Current perioperative antibiotic prophylaxis

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Zusammenfassung

Die perioperative Antibiotikaprophylaxe (PAP) führt zu einer Reduktion postoperativer Wundinfektionen. Voraussetzung für eine optimale PAP sind ausreichende Serum- und Gewebespiegel des eingesetzten Antibiotikums im Wundbereich. Das Antibiotikum muss gegen die wichtigsten während der Operation zu erwartenden Erreger wirksam sein. Das Therapeutikum der Wahl muss für den Patienten sicher sein und eine minimale Nebenwirkungsrate haben. Die Indikationsstellung zur PAP sollte die Risiken des geplanten operativen Eingriffes und vor allem die individuellen Gegebenheiten des Patienten berücksichtigen. In Abhängigkeit von der Pharmakokinetik sollte das Antibiotikum kurzfristig vor Beginn des operativen Eingriffes verabreicht werden. Nach Beendigung der Operation haben weitere Applikationen keinen Einfluss auf die Wundinfektionsrate. Hingegen erhöht sich bei Fortführung der PAP die Rate der Nebenwirkungen (Resistenzen, CDT-positive Kolitis, Allergien). Eingriffsspezifische Empfehlungen erfolgen entsprechend den Leitlinien der Paul-Ehrlich-Gesellschaft.

Abstract

Perioperative antimicrobial prophylaxis (PAP) leads to a reduction in surgical site infections. The aim of PAP is adequate serum and tissue concentrations of the antimicrobial drug in the field of operation. The antibiotic must be effective against the expected pathogens during the operation, safe, and have the fewest possible side effects. The indication for PAP should take into account the risks of the operative procedure and especially the individual risk factors of the patient. Depending on pharmacokinetics, the antibiotic should be administered within 60 min before incision. After closure of the wound, further applications of the antibiotic drug have no influence on the infection rate of the wound but do increase the side effects (resistance, CDT colitis, allergy). Operation-specific recommendations according to guidelines of the Paul Ehrlich Society are given.

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  1. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein – Campus Lübeck, Ratzeburger Allee 160, 23538 , Lübeck

    P. Kujath, R. Bouchard, J. Scheele & H. Esnaashari

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  1. P. Kujath
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  2. R. Bouchard
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  3. J. Scheele
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  4. H. Esnaashari
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Correspondence to P. Kujath.

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Kujath, P., Bouchard, R., Scheele, J. et al. Neues in der perioperativen antibiotischen Prophylaxe. Chirurg 77, 490–498 (2006). https://doi.org/10.1007/s00104-006-1194-3

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  • DOI: https://doi.org/10.1007/s00104-006-1194-3

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