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Endokarditisprophylaxe

Epidemiologie vs. individuelles Schicksal

Endocarditis prophylaxis

Epidemiology versus individual fate

  • Evidenzbasierte Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Endokarditiden sind trotz moderner medikamentöser und chirurgischer Behandlungsstrategien gefährliche Erkrankungen mit nach wie vor hoher Morbidität und Mortalität. Dies gilt insbesondere für Prothesenendokarditiden. Die aktuelle Endokarditisleitlinie der European Society of Cardiology (ESC) aus dem Jahr 2015 sieht einen restriktiven Einsatz der Antibiotikaprophylaxe vor, da eine Zunahme resistenter Bakterienstämme durch den allzu liberalen Einsatz von Antibiotika befürchtet wird. Tatsächlich sind die Anteile multiresistenter Keime auf deutschen Intensivstationen rückläufig, während die Anzahl der Endokarditiden stetig steigt. Angesichts der exzeptionell hohen individuellen Risiken einer Endokarditis sollte die Prophylaxe wieder auf weitere Risikogruppen ausgeweitet werden. Hierzu zählen Dialysepatienten, Träger elektronischer Devices, immunsupprimierte Patienten und Patienten mit anderen Risikoszenarien einer Bakteriämie, wie fieberhaften Infektionen. Dies gilt auch im Licht der uneinheitlichen Datenlage und der unsicheren Evidenz zur Begrenzung des Antibiotikaeinsatzes bei der Endokarditisprävention. Das individuelle Patientenschicksal ist gegen eine rein epidemiologische Betrachtung abzuwägen.

Abstract

Infective endocarditis continues to be a dangerous disease with persistently high morbidity and mortality despite current conservative and surgical treatment strategies. This is especially true for infections of an implanted valvular prosthesis. The current European Society of Cardiology (ESC) endocarditis guidelines published in 2015 recommend a restricted antibiotic prophylaxis for endocarditis because it is feared that an all too liberal use of antibiotic drugs may increase the percentage of multidrug-resistant strains of bacteria. The proportion of multidrug-resistant bacteria in German intensive care units is, however, steadily decreasing whereas the proportion of endocarditis is continuously rising. In view of the exceptionally high individual risks of endocarditis, the prophylaxis should be extended to include other risk groups. These include dialysis patients, wearers of electronic devices, immunosuppressed patients and patients with other risk scenarios for bacteremia, such as febrile infections. This is also true in light of the heterogeneous data and the unsure body of evidence regarding restricted use of antibiotics for the prevention of endocarditis. The individual patient risk should be balanced against a purely epidemiological consideration.

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  1. Herzchirurgie, Immanuel Klinikum Bernau, Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Str. 17, 16321, Bernau, Deutschland

    J. M. Albes MBA

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Albes, J.M. Endokarditisprophylaxe. Z Herz- Thorax- Gefäßchir 32, 492–501 (2018). https://doi.org/10.1007/s00398-018-0233-y

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