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Antibiotikatherapie intraabdomineller Infektionen im Zeitalter der Multiresistenz

Antibiotic therapy of intra-abdominal infections in the era of multiresistance

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Zusammenfassung

Intraabdominelle Infektionen (IAI) bedürfen meist primär einer chirurgischen Herdsanierung. Der Wert einer parallel zur chirurgischen Therapie eingeleiteten Antibiotikatherapie ist jedoch ebenfalls gesichert. IAI weisen meist ein polymikrobielles Erregerspektrum auf. Ambulant erworbene sekundäre Peritonitiden können mit einer Vielzahl von Basissubstanzen behandelt werden. Die postoperative und die tertiäre Peritonitis hingegen zeichnen sich durch ein selektioniertes Spektrum mit resistenten grampositiven und gramnegativen Erregern sowie ggf. auch mit Pilzinfektionen aus. Im gramnegativen Bereich stehen nur noch wenige Substanzen zur Verfügung. Der sinnvolle Einsatz von Antibiotika im Sinne eines als „antibiotic stewardship“ bezeichneten Maßnahmenkataloges dient der Erhaltung der therapeutischen Optionen und der Minderung des Selektionsdrucks in der antimikrobiellen Therapie.

Abstract

Recommendations for the treatment of intra-abdominal infections (IAI) caused by drug-resistant bacteria often fail to mention the bacteria of concern (e.g. vancomycin-resistant enterococci, extended spectrum beta-lactamase-producing (ESBL) Enterobacteriaceae, multi-drug resistant Pseudomonas spp., carbapenem-resistant organisms and Acinetobacter spp.) and all available drugs. The group of patients suffering from IAI due to resistant bacteria includes the entire group of postoperative and tertiary peritonitis and necrotizing pancreatitis. This article provides information for the management of a very important group of diseases with a substantial morbidity and mortality. An individual patient-centered approach is mandatory to evaluate the optimal antimicrobial treatment regimen. Especially in gram-negative bacteria, which are the predominant cause only a few options remain for treatment. Clinical data with a high level of evidence are very limited. Future studies should focus on pharmacokinetic and pharmakodynamic aspects in critically ill patients, in the sense of antibiotic stewardship in order to elucidate the real life efficacy and safety of antibiotics for the treatment of life-threatening IAI.

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  1. Klinik für Allgemein, Viszeral- und Thoraxchirurgie, Klinikum Peine GmbH, Peine, Deutschland

    C. Eckmann

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C. Eckmann gibt an, dass kein Interessenkonflikt besteht.

C. Eckmann hat Honorare für Vorträge und Beratung von folgenden Unternehmen erhalten: AstraZeneca, Bayer, Cubist, Durata, MSD, Novartis, Pfizer.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Eckmann, C. Antibiotikatherapie intraabdomineller Infektionen im Zeitalter der Multiresistenz. Chirurg 87, 26–33 (2016). https://doi.org/10.1007/s00104-015-0106-9

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