Kernaussagen
Antibiotikaresistenzen nehmen weltweit zu. Lokale Trends sind dabei sehr unterschiedlich und müssen bei der Erstellung eines Antibiotikakonzeptes für jede Klinik individuell berücksichtigt werden. Nur wenige neue Antibiotika befinden sich in der „Pipeline” der pharmazeutischen Industrie für die nächsten Jahre, sodass alles getan werden muss, um die Wirksamkeit des vorhandenen Antibiotika-Arsenals zu erhalten. Es besteht nicht nur ein großes Verbesserungspotenzial bei der empirischen Antibiotikatherapie, sondern auch bei der modernen mikrobiologischen Diagnostik. Nur ein multidisziplinärer Ansatz unter Beteiligung von Infektiologen, Klinikern, Mikrobiologen und Apothekern kann zum Erfolg führen. Leitlinien können und sollen das Denken und die individuelle Einschätzung der Patientensituation nicht ersetzen. Antibiotika-Management und Krankenhaushygiene sind die beiden Säulen der Resistenzvermeidung. Eine Bekämpfung der Ausbreitung multiresistenter Erreger ist nur durch die Kombination der beiden Ansätze zu optimieren: Blockierung der Übertragungswege und gleichzeitiger rationaler Antibiotikaeinsatz.
Literatur
-
1
Centers for Disease Control and Prevention .
Vancomycin-resistant Staphylococcus aureus – New York, 2004.
Morb Mortal Wkly Rep.
2004;
53
322-323
-
2
Meka V G, Pillai S K, Sakoulas G et al.
Linezolid resistance in sequential Staphylococcus aureus isolates associated with a T2500A mutation in the 23S rRNA gene and loss of a single copy of rRNA.
J Infect Dis.
2004;
190
311-317
-
3
Meyer E, Schwab F, Pollitt A et al.
Impact of a change in antibiotic prophylaxis on total antibiotic use in a surgical intensive care unit.
Infection.
2010;
38
19-24
-
4
World Health Organization .
WHO Workshop on containment of antimicrobial resistance in Europe, 26 – 27 February 2004 in Wernigerode, Germany.
Bundesgesundhbl.
2004;
48
221-231
-
5
Meyer E, Schwab F, Jonas D et al.
Temporal changes in bacterial resistance in German intensive care units, 2001 – 2003: data from the SARI (surveillance of antimicrobial use and antimicrobial resistance in intensive care units) project.
J Hosp Infect.
2005;
62
181-186
-
6 Meyer E, Jonas D, Schwab F et al. MRSA und Antibiotikaverbrauch auf Intensivstationen in Deutschland.. DGHM Kongress Münster; 2004
-
7
Meyer E, Jonas D, Schwab F et al.
SARI: surveillance of antibiotic use and bacterial resistance in German intensive care units. Correlation between antibiotic use and the emergence of resistance.
Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz.
2004;
47
345-351
-
8
Just H-M.
DART – ein Pfeil ins Nichts?.
Krankenh hyg up2date.
2008;
4
297
-
9
Meyer E, Ebner W, Heininger A et al.
Microbiological diagnostic and antibiotic management of community aquired and nosocomial pneumonias in intensive care units in Germany.
Anaesth Intensivther Notfallmed.
2005;
40
85-90
-
10
Lustig A.
Medication error prevention by pharmacists – an Israeli solution.
Pharm World Sci.
2000;
22
21-25
-
11 Fishman N O. Antimicrobial management and cost containment.. In: Mandell G L, Bennett J E, Dolin R D eds. Principles and practice of infectious diseases. 5. ed.. New York: Churchill Livingstone; 2005: 539-546
-
12
Pittet D, Eggimann P, Harbarth S, Sax H.
Optimierte Antibiotika-Anwendung in der Intensivstation.
Swiss-NOSO.
2004;
11
11-13
-
13
Kollef M H, Fraser V J.
Antibiotic resistance in the intensive care unit.
Ann Intern Med.
2001;
134
298-314
-
14
McHugh C G, Riley L W.
Risk factors and costs associated with methicillin-resistant Staphylococcus aureus bloodstream infections.
Infect Control Hosp Epidemiol.
2004;
25
425-430
-
15
Giblin T B, Sinkowitz-Cochran R L, Harris P L et al.
Clinicians' perceptions of the problem of antimicrobial resistance in health care facilities.
Arch Intern Med.
2004;
164
1662-1668
-
16
Meyer E, Schwab F, Pollit A et al.
Impact of a change in antibiotic prophylaxis on total antibiotic use in a surgical intensive care unit.
Infection.
2010;
38
19-24
-
17
Goldmann D A, Weinstein R A, Wenzel R P et al.
Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership.
J Amer Med Assoc.
1996;
275
234-240
-
18
Rahal J J, Urban C, Horn D et al.
Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella.
J Amer Med Assoc.
1998;
280
1233-1237
-
19
Paul M, Uri-Silbiger I, Soares-Weiser K, Leibovici L.
Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials.
Brit Med J.
2004;
328
668
-
20
Safdar N, Handelsman J, Maki D G.
Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis.
Lancet Infect Dis.
2004;
4
519-527
-
21
Kollef M H.
The importance of appropriate initial antibiotic therapy for hospital-acquired infections.
Am J Med.
2003;
115
582-584
-
22
Micek S T, Ward S, Fraser V J, Kollef M H.
A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia.
Chest.
2004;
125
1791-1799
-
23
Singh N, Rogers P, Atwood C W et al.
Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription.
Am J Respir Crit Care Med.
2000;
162
505-511
-
24
Meyer E, Schwab F, Jonas D et al.
Surveillance of antimicrobial use and antimicrobial resistance in intensive care units (SARI): 1. Antimicrobial use in German intensive care units.
Intensive Care Med.
2004;
30
1089-1096
-
25
de GD , Beutels P.
Economic aspects of pneumococcal pneumonia: a review of the literature.
Pharmacoeconomics.
2004;
22
719-740
-
26
Ramirez J A, Srinath L, Ahkee S et al.
Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia.
Arch Intern Med.
1995;
155
1273-1276
-
27
Ramsay C, Brown E, Hartman G, Davey P.
Room for improvement: a systematic review of the quality of evaluations of interventions to improve hospital antibiotic prescribing.
J Antimicrob Chemother.
2003;
52
764-771
-
28
Reluga T C.
Simple models of antibiotic cycling.
Math Med Biol.
2005;
22
187-208
-
29
Bruno-Murtha L A, Brusch J, Bor D et al.
A pilot study of antibiotic cycling in the community hospital setting.
Infect Control Hosp Epidemiol.
2005;
26
81-87
-
30
Lemmen S W, Becker G, Frank U, Daschner F D.
Influence of an infectious disease consulting service on quality and costs of antibiotic prescriptions in a university hospital.
Scand J Infect Dis.
2001;
33
219-221
-
31
Gross R, Morgan A S, Kinky D E et al.
Impact of a hospital-based antimicrobial management program on clinical and economic outcomes.
Clin Infect Dis.
2001;
33
289-295
-
32
Just H-M.
Antibiotika im ambulant & stationären Bereich.
Krankenh hyg up2date.
2006;
1
37-52
-
33
Ruttimann S, Keck B, Hartmeier C et al.
Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital.
Clin Infect Dis.
2004;
38
348-356
Dr. med. Thomas Hauer
Ärztlicher Leiter, Facharzt für Hygiene und Umweltmedizin
Infektiologe (DGI)
Deutsches Beratungszentrum für Hygiene, BZH-GmbH
Schnewlinstr. 10
79098 Freiburg
hauer@bzh-freiburg.de
