Multiresistente Erreger – Infektionsmanagement 2015

Zusammenfassung

Die Ausbreitung multiresistenter Erreger (MRE) ist eine globale Bedrohung der öffentlichen Gesundheit. Die Bekämpfung der MRE-Ausbreitung erfordert gesamtgesellschaftliche Anstrengungen, die in der deutschen Antibiotika-Resistenz-Strategie gebündelt werden. Im Krankenhaussektor gehören hierzu vor allem i) eine rationale an der lokalen Resistenzsituation ausgerichtete Antibiotikatherapie, die durch Antibiotic Stewardship strukturiert gefördert werden soll und ii) stringente Hygienemaßnahmen.

Die Therapie von MRE-Infektionen ist komplex. In den letzten Jahren wurden mehrere Antibiotika mit MRSA-Wirksamkeit eingeführt, die mittlerweile eine an Infektionsfokus und Komorbiditäten ausgerichtete individuelle Therapie ermöglichen. Neue Medikamente gegen mit Wirksamkeit gegen Carbapenem-resistente, gramnegative Errerger wurden bislang nicht eingeführt. Neuere Studien zeigen, dass hier eine gezielte, auf der alten Substanz Colistin basierende Kombinationstherapie die Prognose verbessern kann.

Der folgende Artikel gibt einen Überblick über Definition, Krankheitslast, Therapieoptionen und generelle Strategien gegen MRE.

Abstract

The global spread of multi-drug resistant organisms (MDRO) is a major threat to public health. Fighting MDRO spread requires a multi-faceted approach as summarized in the German Antibiotic Resistance Strategy (DART). In the hospital, this includes antibiotic stewardship concepts and strict infection control measures. Treatment of MDRO is sophisticated. Within the last years, several antibiotics with activity against MRSA were launched and facilitate an individual therapy according to site of infection and co-morbidities. In contrast, novel antibiotics against carbapenemase producing Gram-negatives are still lacking. Current studies have shown, that a colistin-based combination treatment can improve the prognosis in these patients. The following article reviews MDRO definitions, burden of disease, treatment options and general strategies against MDRO.

Schlüsselwörter

rationale Antibiotikatherapie - Multiresistenz - ESKAPE - Deeskalation

Keywords

Antibiotic Stewardship - multi-drug resistant organism - ESKAPE - deescalation therapy

• Literatur

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