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Intensivmedizin up2date 2025; 21(01): 77-90
DOI: 10.1055/a-2358-6044
Operative Intensivmedizin

Management postoperativer Infektionen nach thoraxchirurgischen Eingriffen

Jan Fertmann
,
Christian Schneider
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Nosokomiale Infektionen des Operationsgebietes und des operativen Zugangsweges („surgical site infections“, SSI) sind in der postoperativen Phase nach thoraxchirurgischen Eingriffen, trotz der zunehmenden Verbreitung minimalinvasiver und atraumatischer Operationsverfahren, weiter ein relevantes klinisches Problem. Sie können abhängig von Lokalisation und Ausdehnung mit einer hohen Morbidität und Mortalität einhergehen.
Kernaussagen

  • Postoperative Infektionen nach thoraxchirurgischen Eingriffen bedingen eine hohe Morbidität und Mortalität.

  • Bekannte personen- und prozedurengebundene Risikofaktoren müssen im gesamten perioperativen Verlauf konsequent adressiert werden, um eine Risikominimierung zu erreichen.

  • Für eine intraoperative Antibiotikaprophylaxe besteht bei thoraxchirurgischen Eingriffen eine klare Evidenz.

  • Oberflächliche Wundinfektionen im operativen Zugangsweg werden stadienadaptiert zunächst lokal behandelt, eine Antibiotikatherapie ist nur bei systemischen Infektzeichen oder Auftreten einer phlegmonösen Entzündung indiziert.

  • Bei Auftreten von schweren Komplikationen wie Bronchusstumpfinsuffizienz oder postoperativem Pleuraempyem ist eine rasche, ebenfalls stadienadaptierte Therapie unabdinglich, die bis hin zur Anlage eines Thorakostomas oder einer Thorakoplastik führen kann.

Schlüsselwörter

Infektiologie - Thoraxchirurgie - Bronchusstumpfinsuffizienz - Anastomoseninsuffizienz


Publication History

Article published online:
05 March 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
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