Kontroversen im Management schwerer Staphylokokkeninfektionen

Was ist neu?

Staphylococcus-aureus-Bakteriämie Cefazolin ist bei unkomplizierter S. aureus-Bakteriämie in ausreichend hoher Dosierung (3 × 2 g/Tag i. v.) vermutlich eine gleichwertige Alternative zu Flucloxacillin. Bei Patienten mit implantierten Fremdkörpern kann eine Kombinationstherapie (zellwandaktives Antibiotikum plus Rifampicin oder Fosfomycin) zu verbessertem Überleben und geringerer Rezidivrate führen. Die Therapiedauer bei unkomplizierter S. aureus-Bakteriämie beträgt weiterhin 14 Tage.

Staphylococcus aureus-Endokarditis Einige der Empfehlungen zur Therapie der S. aureus-Endokarditis in der neuen ESC-Leitlinie sind umstritten. Die Indikation zur Echokardiografie bei Patienten mit S. aureus-Bakteriämie kann risikoadaptiert gestellt werden – dafür gibt es mehrere neue Bewertungsschemata. Bisher ist unklar, welches Schema am geeignetsten ist, jedoch bestehen Gemeinsamkeiten.

• Literatur

• 1 Paul M. Zemer-Wassercug N. Talker O. et al. Are all beta-lactams similarly effective in the treatment of methicillin-sensitive Staphylococcus aureus bacteraemia?. Clin Microbiol Infect 2011; 17: 1581-1586
• 2 Bai AD. Showler A. Burry L. et al. Comparative effectiveness of cefazolin versus cloxacillin as definitive antibiotic therapy for MSSA bacteraemia: results from a large multicentre cohort study. J Antimicrob Chemother 2015; 70: 1539-1546
• 3 Pollett S. Baxi SM. Rutherford GW. et al. Cefazolin versus Nafcillin for Methicillin-Sensitive Staphylococcus aureus Bloodstream Infection in a California Tertiary Medical Center. Antimicrob Agents Chemother 2016; 60: 4684-4689
• 4 Davis JS. Sud A. O'Sullivan MV. et al. Combination of Vancomycin and beta-Lactam Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: A Pilot Multicenter Randomized Controlled Trial. Clin Infect Dis 2016; 62: 173-180
• 5 Forsblom E. Ruotsalainen E. Jarvinen A. Improved outcome with early rifampicin combination treatment in methicillin-sensitive Staphylococcus aureus bacteraemia with a deep infection focus – a retrospective cohort study. PLoS One 2015; 10: e0122824
• 6 Rieg S. Joost I. Weiss V. et al. Combination antimicrobial therapy in patients with Staphylococcus aureus bacteraemia-a post hoc analysis in 964 prospectively evaluated patients. Clin Microbiol Infect 2016;
• 7 Kaasch AJ. Fatkenheuer G. Prinz-Langenohl R. et al. Early oral switch therapy in low-risk Staphylococcus aureus bloodstream infection (SABATO): study protocol for a randomized controlled trial. Trials 2015; 16: 450
• 8 Paul M. Bishara J. Yahav D. et al. Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial. BMJ 2015; 350: h2219
• 9 Habib G. Lancellotti P. Antunes MJ. et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 3075-3128
• 10 Baddour LM. Wilson WR. Bayer AS. et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132: 1435-1486
• 11 Tubiana S. Duval X. Alla F. et al. The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia. J Infect 2016; 72: 544-553
• 12 Palraj BR. Baddour LM. Hess EP. et al. Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT): Scoring System to Guide Use of Echocardiography in the Management of Staphylococcus aureus Bacteremia. Clin Infect Dis 2015; 61: 18-28
• 13 Showler A. Burry L. Bai AD. et al. Use of Transthoracic Echocardiography in the Management of Low-Risk Staphylococcus aureus Bacteremia: Results From a Retrospective Multicenter Cohort Study. JACC Cardiovasc Imaging 2015; 8: 924-931
• 14 Kaasch AJ. Fowler Jr VG. Rieg S. et al. Use of a simple criteria set for guiding echocardiography in nosocomial Staphylococcus aureus bacteremia. Clin Infect Dis 2011; 53: 1-9
• 15 Buitron de la Vega P. Tandon P. Qureshi W. et al. Simplified risk stratification criteria for identification of patients with MRSA bacteremia at low risk of infective endocarditis: implications for avoiding routine transesophageal echocardiography in MRSA bacteremia. Eur J Clin Microbiol Infect Dis 2016; 35: 261-268
• 16 Gow N. Lowe BS. Freeman J. et al. The role of echocardiography in Staphylococcus aureus bacteraemia at Auckland City Hospital. N Z Med J 2015; 128: 28-35
• 17 Heriot G. Yeoh J. Street A. et al. Echocardiografy has minimal yield and may not be warranted in Staphylococcus aureus bacteremia without clinical risk factors for endocarditis. Eur J Clin Microbiol Infect Dis 2015; 34: 1231-1236
• 18 Barton T. Moir S. Rehmani H. et al. Low rates of endocarditis in healthcare-associated Staphylococcus aureus bacteremia suggest that echocardiography might not always be required. Eur J Clin Microbiol Infect Dis 2016; 35: 49-55