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Urosepsis und Therapie

Urosepsis and treatment

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Zusammenfassung

Die Urosepsis gehört zu den häufigsten Sepsisentitäten. Die Letalität der Urosepsis liegt heutzutage weitgehend unter der anderer Sepsisentitäten. Pathophysiologisch ist das Sepsissyndrom durch eine generalisierte Infektion und Immundysregulation charakterisiert. Exogene mikrobiologische und aktiv oder passiv freigesetzte endogene Faktoren aus körpereigenen Zellen initiieren und begleiten die Immundysregulation. Die Diagnostik und Therapie der Urosepsis muss so früh wie möglich (innerhalb der ersten Stunde) erfolgen, um die Zell- und Gewebeschädigung im Frühstadium verhindern zu können. Hierzu wird ein Maßnahmenpaket initiiert, welches eine frühe Fokuskontrolle und Antibiotikatherapie, sowie die Stabilisierung der Atem- und Kreislauffunktion zur Optimierung der Gewebeoxygenierung beinhaltet. Ein wichtiges klinisches Problem stellt die zunehmende Antibiotikaresistenz v. a. der Enterobakterien dar. Die Antibiotikaauswahl richtet sich deswegen nach der lokalen Erregerresistenzstatistik. Die Applikation der Antibiotika sollte sich sowohl an den individuellen Merkmalen des Patienten als auch den aktuellen pharmakokinetischen/-dynamischen Erkenntnissen orientieren. Der septische Patienten muss bei Krankenhausaufnahme oder im Falle stationärer Patienten auf Normalstation zügig identifiziert werden um die intensive Behandlung unmittelbar zu beginnen bevor sie gegebenenfalls auf der Intensivstation weitergeführt werden muss.

Abstract

Urosepsis is one of the most frequent sepsis entities. Mortality from urosepsis is nowadays mostly lower than from other entities. Sepsis syndrome is pathophysiologically characterized by a generalized infection and immune dysregulation. Exogenous microbiological and active or passive endogenous factors released from body cells initiate and accompany the immune dysregulation. Diagnosis and therapy of urosepsis need to be instigated as early as possible (within the first hour), in order to prevent cell and tissue damage in the early phase. For this reason a series of measures is started, aimed at achieving early control of the focus of infection, providing antibiotic treatment, and stabilizing respiratory and cardiovascular function in order to optimize tissue oxygenation. A significant clinical problem ensues due to increasing antibiotic resistance mainly of enterobacteria. The choice of antibiotic therefore is made on the basis of local antibiotic resistance statistics. Dosage is determined on an individual basis, as well as according to current pharmacokinetic/pharmacodynamic knowledge. The intensive care of the septic patient needs to be started as early as on patient admission and, where necessary, continued on the intensive care ward.

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Literatur

  1. Angus DC, Linde-Zwirble WT, Lidicker J et al (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome and associated costs of care. Crit Care Med 29(7):1303–1310

    Article  CAS  PubMed  Google Scholar 

  2. Hotchkiss RS, Karl IE (2003) The pathophysiology and treatment of sepsis. N Engl J Med 348(2):138–150

    Article  CAS  PubMed  Google Scholar 

  3. Angus DC, Wax RS (2001) Epidemiology of sepsis: an update. Crit Care Med 29(Suppl 7):109–116

    Article  Google Scholar 

  4. Brunkhorst FM (2006) Epidemiology, economy and practice – results of the German study on prevalence by the competence network sepsis (SepNet). Anasthesiol Intensivmed Notfallmed Schmerzther 41(1):43–44

    Article  CAS  PubMed  Google Scholar 

  5. Moerer O, Schmid A, Hofmann M et al (2002) Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med 28(10):1440–1446

    Article  PubMed  Google Scholar 

  6. Book M, Lehmann LE, Schewe JC et al (2005) Urosepsis. Current therapy and diagnosis. Urologe A 44(4):413–4224

    Article  CAS  PubMed  Google Scholar 

  7. Wagenlehner FM, Pilatz A, Naber KG, Weidner W (2008) Therapeutic challenges of urosepsis. Eur J Clin Invest 38(Suppl 2):45–49

    Article  PubMed  Google Scholar 

  8. Wagenlehner FM, Weidner W, Naber KG (2007) Optimal management of urosepsis from the urological perspective. Int J Antimicrob Agents 30(5):390–397

    Article  CAS  PubMed  Google Scholar 

  9. Vincent JL, Rello J, Marshall J et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302(21):2323–2329

    Article  CAS  PubMed  Google Scholar 

  10. Kreger BE, Craven DE, Carling PC, McCabe WR (1980) Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients. Am J Med 68(3):332–343

    Article  CAS  PubMed  Google Scholar 

  11. Kreger BE, Craven DE, McCabe WR (1980) Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 68(3):344–355

    Article  CAS  PubMed  Google Scholar 

  12. Bone RC, Balk RA, Cerra FB et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/society of critical care medicine. Chest 101(6):1644–1655

    Article  CAS  PubMed  Google Scholar 

  13. Bone RC, Sprung CL, Sibbald WJ (1992) Definitions for sepsis and organ failure. Crit Care Med 20(6):724–726

    Article  CAS  PubMed  Google Scholar 

  14. Dellinger RP, Levy MM, Carlet JM et al (2008) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 34(1):17–60

    Article  PubMed  Google Scholar 

  15. Dellinger RP, Vincent JL (2005) The surviving sepsis campaign sepsis change bundles and clinical practice. Crit Care 9(6):653–654

    Article  PubMed  Google Scholar 

  16. Adib-Conquy M, Cavaillon JM (2007) Stress molecules in sepsis and systemic inflammatory response syndrome. FEBS Lett 581(19):3723–3733

    Article  CAS  PubMed  Google Scholar 

  17. Isermann B, Bierhaus A, Humpert PM et al (2004) AGE-RAGE: a hypothesis or a mechanism? Herz 29(5):504–509

    Article  PubMed  Google Scholar 

  18. Kislinger T, Tanji N, Wendt T et al (2001) Receptor for advanced glycation end products mediates inflammation and enhanced expression of tissue factor in vasculature of diabetic apolipoprotein E-null mice. Arterioscler Thromb Vasc Biol 21(6):905–910

    CAS  PubMed  Google Scholar 

  19. Ritthaler U, Deng Y, Zhang Y et al (1995) Expression of receptors for advanced glycation end products in peripheral occlusive vascular disease. Am J Pathol 146(3):688–694

    CAS  PubMed  Google Scholar 

  20. Meisner M, Brunkhorst FM, Reith HB et al (2000) Clinical experiences with a new semi-quantitative solid phase immunoassay for rapid measurement of procalcitonin. Clin Chem Lab Med 38(10):989–995

    Article  CAS  PubMed  Google Scholar 

  21. Calfee CS, Ware LB, Eisner MD et al (2008) Plasma receptor for advanced glycation end products and clinical outcomes in acute lung injury. Thorax 63(12):1083–1089

    Article  CAS  PubMed  Google Scholar 

  22. Liliensiek B, Weigand MA, Bierhaus A et al (2004) Receptor for advanced glycation end products (RAGE) regulates sepsis but not the adaptive immune response. J Clin Invest 113(11):1641–1650

    CAS  PubMed  Google Scholar 

  23. Zhang H, Tasaka S, Shiraishi Y et al (2008) Role of soluble receptor for advanced glycation end products on endotoxin-induced lung injury. Am J Respir Crit Care Med 178(4):356–362

    Article  CAS  PubMed  Google Scholar 

  24. Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345(19):1368–1377

    Article  CAS  PubMed  Google Scholar 

  25. Dellinger RP, Levy MM, Carlet JM et al (2008) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36(1):296–327

    Article  PubMed  Google Scholar 

  26. Reinhart K, Brunkhorst F, Bone H et al (2006) Diagnosis and therapy of sepsis. Guidelines of the German Sepsis Society Inc. and the German interdisciplinary society for intensive and emergency medicine. Internist (Berl) 47(4):356–368

    Google Scholar 

  27. Brunkhorst FM, Reinhart K (2009) Diagnosis and causal treatment of sepsis. Internist (Berl) 50(7):810–816

    Google Scholar 

  28. Elhanan G, Sarhat M, Raz R (1997) Empiric antibiotic treatment and the misuse of culture results and antibiotic sensitivities in patients with community-acquired bacteraemia due to urinary tract infection. J Infect 35(3):283–288

    Article  CAS  PubMed  Google Scholar 

  29. Kollef MH, Ward S (1998) The influence of mini-BAL cultures on patient outcomes: implications for the antibiotic management of ventilator-associated pneumonia. Chest 113(2):412–420

    Article  CAS  PubMed  Google Scholar 

  30. Kumar A, Haery C, Paladugu B et al (2006) The duration of hypotension before the initiation of antibiotic treatment is a critical determinant of survival in a murine model of Escherichia coli septic shock: association with serum lactate and inflammatory cytokine levels. J Infect Dis 193(2):251–258

    Article  CAS  PubMed  Google Scholar 

  31. Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34(6):1589–1596

    Article  PubMed  Google Scholar 

  32. Menninger M (1998) Urosepsis, Klinik, Diagnostik und Therapie. In: Hofstetter A (Hrsg) Urogenitale Infektionen. Springer, Berlin Heidelberg New York, S 521–528

  33. Rosenthal EJ (2002) Epidemiology of septicaemia pathogens. Dtsch Med Wochenschr 127(46):2435–2440

    Article  CAS  PubMed  Google Scholar 

  34. Grabe H, Bishop MC, Bjerklund-Johansen TE et al. (2009) EAU guidelines on the management of urinary and male genital tract infections. EAU working group on urinary and male genital tract infections. In: Office. EAoUEG (ed) EAU guidelines 2009 edn. EAU guidelines office, pp 1–116

  35. Ho PL, Chan WM, Tsang KW et al (2002) Bacteremia caused by Escherichia coli producing extended-spectrum beta-lactamase: a case-control study of risk factors and outcomes. Scand J Infect Dis 34(8):567–573

    Article  PubMed  Google Scholar 

  36. Kizirgil A, Demirdag K, Ozden M et al (2005) In vitro activity of three different antimicrobial agents against ESBL producing Escherichia coli and Klebsiella pneumoniae blood isolates. Microbiol Res 160(2):135–140

    Article  CAS  PubMed  Google Scholar 

  37. Schwaber MJ, Carmeli Y (2007) Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 60(5):913–920

    Article  CAS  PubMed  Google Scholar 

  38. Bjerklund Johansen TE, Cek M, Naber K et al (2007) Prevalence of hospital-acquired urinary tract infections in urology departments. Eur Urol 51(4):1100–1112

    Article  Google Scholar 

  39. Wagenlehner FM, Weidner W, Naber KG (2007) Pharmacokinetic characteristics of antimicrobials and optimal treatment of urosepsis. Clin Pharmacokinet 46(4):291–305

    Article  CAS  PubMed  Google Scholar 

  40. Hofmann W (1990) Urosepsis and uroseptic shock. Z Urol Nephrol 83(6):317–324

    CAS  PubMed  Google Scholar 

  41. Vahlensieck W (2006) Infizierte Harnstauungsniere und Pyonephrose. In: Schmelz HU, Sparwasser C, Weidner W (Hrsg) Facharztwissen Urologie. Springer, Berlin Heidelberg New York, S 24

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Astellas Europa, Rosen-Pharma, Pierre-Fabre, Seray Wassner.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH – Standort Gießen, Justus-Liebig-Universität, Rudolf-Buchheim-Straße 7, 35385, Gießen, Deutschland

    F.M.E. Wagenlehner & W. Weidner

  2. Abteilung für Anästhesie, operative Intensivmedizin und Schmerztherapie, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    C. Lichtenstern & M.A. Weigand

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  1. F.M.E. Wagenlehner
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  2. C. Lichtenstern
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  3. M.A. Weigand
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  4. W. Weidner
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Correspondence to F.M.E. Wagenlehner.

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Wagenlehner, F., Lichtenstern, C., Weigand, M. et al. Urosepsis und Therapie. Urologe 49, 618–622 (2010). https://doi.org/10.1007/s00120-010-2253-4

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