Antibiotic Stewardship in Orthopädie und Unfallchirurgie

Zusammenfassung

In Zeiten steigender Antibiotikaresistenzen wird der rationale Umgang mit Antiinfektiva immer wichtiger. „Antibiotic Stewardship“ (ABS) ist ein Konzept, bei dem versucht wird, in interdisziplinärer Zusammenarbeit von Chirurgen, Infektiologen, Apothekern und Mikrobiologen das Antibiotikamanagement, die Aspekte der Diagnostik und Infektionsprävention zu optimieren.

Abstract

As antimicrobial resistance is increasing, it is becoming more and more important to optimise the prudent use of anti-infectives. In this context, “antibiotic stewardship” (ABS) describes a concept which involves surgeons, infectiologists, pharmacists and microbiologists in an interdisciplinary approach in order to optimise antibiotic management and the prevention and diagnosis of infections.

• Literatur

• 1 Behnke M, Hansen S, Leistner R. et al. Nosocomial infection and antibiotic use: a second national prevalence study in Germany. Dtsch Arztebl Int 2013; 110: 627-633
• 2 Renz N, Müller M, Perka C. et al. Implantatassoziierte Infektion – Diagnostik. Chirurg 2016; 87: 813-821
• 3 Dowsey MM, Choong PFM. Obesity is a major risk factor for prosthetic infection after primary hip arthroplasty. Clin Orthop Relat Res 2008; 466: 153-158
• 4 Kampf G, Gastmeier P, Wischnewski N. et al. Analysis of risk factors for nosocomial infections – results from the first national prevalence survey in Germany (NIDEP Study, Part 1). J Hosp Infect 1997; 37: 103-112
• 5 Kaye KS, Schmit K, Pieper C. et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis 2005; 191: 1056-1062
• 6 Berkes M, Obremskey WT, Scannell B. et al. Maintenance of hardware after early postoperative infection following fracture internal fixation. J Bone Joint Surg Am 2010; 92: 823-828
• 7 Tschudin-Sutter S, Frei R, Dangel M. et al. Validation of a treatment algorithm for orthopaedic implant-related infections with device-retention-results from a prospective observational cohort study. Clin Microbiol Infect 2016; 22: 457.e1-459.e1
• 8 Çakmakçi M. Antibiotic stewardship programmes and the surgeonʼs role. J Hosp Infect 2015; 89: 264-266
• 9 Dik JH, Poelman R, Friedrich AW. et al. An integrated stewardship model: antimicrobial, infection prevention and diagnostic (AID). Future Microbiol 2016; 11: 93-102
• 10 Nicolau DP. Current challenges in the management of the infected patient. Curr Opin Infect Dis 2011; 24 (Suppl. 01) S1-S10
• 11 Owens jr. RC, Shorr AF, Deschambeault AL. Antimicrobial stewardship: shepherding precious resources. Am J Health Syst Pharm 2009; 66 (Suppl. 04) S15-S22
• 12 Hübner C, Hübner N, Muhr M. et al. Cost analysis of hospitalized Clostridium difficile-associated diarrhea (CDAD). GMS Hyg Infect Control 2015; 10: Doc13
• 13 Kern WV, Fätkenheuer G, Tacconelli E. et al. Klinische Infektiologie in Deutschland und Europa. Z Evid Fortbild Qual Gesundhwes 2015; 109: 493-499
• 14 Forsblom E, Ruotsalainen E, Ollgren J. et al. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2013; 56: 527-535
• 15 Nanchahal J. Standards for the Management of open Fractures of the lower Limb. London: Royal Society of Medicine Press Ltd.; 2009
• 16 Hoff WS, Bonadies JA, Cachecho R. et al. East Practice Management Guidelines Work Group: update to practice management guidelines for prophylactic antibiotic use in open fractures. J Trauma 2011; 70: 751-754
• 17 Horn D, Roßlenbroich S, Köck R, Kreis CAA, Roeder N, Raschke M, Fuchs T. Klinische Pharmazeuten als Teil eines interdisziplinären Teams bei der Antibiotikatherapie in der Unfallchirurgie. Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2015). Berlin, 20.–23. 10. 2015. Düsseldorf: German Medical Science GMS Publishing House; 2015: DocWI57-1119
• 18 Kaplan JB. Antibiotic-induced biofilm formation. Int J Artif Organs 2011; 34: 737-751
• 19 Roberts JA, Paul SK, Akova M. et al. DALI: defining antibiotic levels in intensive care unit patients: are current β-lactam antibiotic doses sufficient for critically ill patients?. Clin Infect Dis 2014; 58: 1072-1083
• 20 Cooke FJ, Matar R, Lawson W. et al. Comment on: Antibiotic stewardship – more education and regulation not more availability?. J Antimicrob Chemother 2010; 65: 598
• 21 Vercheval C, Gillet M, Maes N. et al. Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey. Eur J Clin Microbiol Infect Dis 2016; 35: 1495-1500