Zusammenfassung
Es gibt eine Reihe von praktische relevanten Neuigkeiten zum Thema Bakteriämie und Sepsis. Dazu gehört die Empfehlung in der neuen überarbeiteten deutschen Sepsisleitlinie, die selektive Darmdekontamination mit nicht-resorbierbaren antimikrobiellen Substanzen als Prophylaxe von Sekundärinfektionen bei beatmeten Patienten anzuwenden. Diese Maßnahme bleibt aber nach wie vor umstritten, da es Hinweise auf ungünstige Wirkungen gibt (vermehrte Resistenzentwicklung) und die Effektstärke gering erscheint. Neuere Daten zeigen nicht nur, dass Procalcitonin bei ambulant erworbenen Atemwegsinfektionen und Pneumonie als Hilfe zur Steuerung der Antibiotikatherapiedauer sinnvoll eingesetzt werden kann. Auch bei Intensivpatienten scheint damit eine Verkürzung der Antibiotikatherapiedauer bei gleicher Prognose möglich. E. coli und S. aureus sind nach wie vor die häufigsten Erreger von bakteriämie und Sepsis. Die Rate an ESBL-Produzenten unter E.-coli-Isolaten nimmt zu. Nach neueren Untersuchungen ist die Infektion aufgrund der Resistenz gegenüber vielen Standardantibiotika mit einer Übersterblichkeit assoziiert, ebenso wie MRSA-Bakteriämien, deren Häufigkeit nun aufgrund der Meldepflicht besser abgeschätzt werden kann.
Abstract
Recent news in the field of bloodstream infection and sepsis relevant for the practitioner include the recommendation in the newly revised German sepsis guideline to introduce selective intestinal decontamination with non-absorbable antimicrobial substances for the prevention of secondary infections in ventilated patients. This intervention, however, remains controversial because there are indications of unfavourable effects (increased development of resistance), and because the effect size has been rather low. Other news indicate not only that procalcitonin can be reasonably used as an aid to determine the duration of antibiotic treatment in community-acquired respiratory infection and pneumonia. A procalcitonin-based algorithm can also be used in critical care patients to shorten the duration of antibiotic administration without worsening outcomes. Recent data indicate that E. coli and S. aureus continue to be the most frequent pathogens isolated in bloodstream infection. The proportion of E. coli strains producing extended-spectrum beta lactamase (ESBL) is increasing. New epidemiologic evidence shows that infections with this pathogen, resistant to many standard antibiotics, are associated with an increased mortality rate, similar to infections due to methicillin-resistant Staphylococcus aureus (MSRA). The incidence of MRSA bacteraemia in Germany can now be estimated better as it has become a notifiable infection.
Schlüsselwörter
Bakteriämie - Sepsis - Darmdekontamination - Procalcitonin - Splenektomie
Keywords
bacteriemia - sepsis - selective decontamination - procalcitonin - asplenia
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Prof. Dr. Winfried V. Kern
Zentrum Infektiologie und Reisemedizin
Medizinische
Universitätsklinik
Hugstetter Str. 55
79106
Freiburg
eMail: kern@if-freiburg.de
