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14.09.2017 | Infektiologie

Antibiotic Stewardship 2.0

Individualisierung der Therapie

verfasst von: Prof. Dr. Mathias W. Pletz, Prof. Dr. Evelina Tacconelli, Prof. Dr. Tobias Welte

Erschienen in: Wiener klinisches Magazin | Ausgabe 5/2017

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Zusammenfassung

Im Spannungsfeld zwischen der Ausbreitung multiresistenter Erreger und dem Fehlen neuer Substanzen wird der rationale Umgang mit Antibiotika immer wichtiger, vor allem bei multiresistenten gramnegativen Erregern. Denn Resistenzentwicklung ist bakterielle Evolution und damit nicht vermeidbar, kann aber durch einen restriktiven Einsatz von Antibiotika zumindest verzögert werden. Dieses Ziel verfolgt Antibiotic Stewardship (ABS). ABS hat zwei Dimensionen – eine strukturelle und eine individuelle. Bei ersterer geht es um den Aufbau von ABS-Teams, die Analyse von lokalen Verbrauchs- und Resistenzdaten sowie die Implementierung entsprechender Empfehlungen und Algorithmen in der Klinik. Letztere beinhaltet konkrete, individuelle Entscheidungen am Patientenbett: Wie kann man (Breitspektrum‑)Antibiotika sparen, ohne den Patienten zu gefährden? Dabei geht es insbesondere um die Deeskalation einer initialen Breitspektrum- oder Kombinationstherapie, um die Begrenzung der Therapiedauer und um das Vermeiden von Fehlindikationen. Typische Fehlindikationen für Antibiotika im stationären und ambulanten Sektor sind vor allem asymptomatische Bakteriurie und virale Atemwegsinfektionen einschließlich der nicht bakteriell bedingten akuten Exazerbation der chronisch-obstruktiven Lungenerkrankung. Im stationären Bereich sind zusätzlich unter anderem die respiratorische Kolonisation und ventilatorassoziierte Tracheobronchitis, die prolongierte perioperative Prophylaxe und kontaminierte Blutkulturen zu nennen. ABS wird zukünftig von einer schnelleren Erreger- und Resistenzdiagnostik profitieren, denn eine frühzeitige gezielte Therapie reduziert den unnötigen Verbrauch von Breitspektrumantibiotika und kann darüber hinaus das individuelle Outcome des Patienten verbessern.
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Metadaten
Titel
Antibiotic Stewardship 2.0
Individualisierung der Therapie
verfasst von
Prof. Dr. Mathias W. Pletz
Prof. Dr. Evelina Tacconelli
Prof. Dr. Tobias Welte
Publikationsdatum
14.09.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 5/2017
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-017-0192-z

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