Infektionen unter medikamentöser Immunsuppression bei transplantierten Intensivpatienten

Kernaussagen

Eine strenge Expositionskontrolle gegenüber der Vielzahl potenzieller Erreger ist vor allen anderen Maßnahmen entscheidend bei der intensivmedizinischen Betreuung immunsupprimierter Patienten. Dazu gehören z. B. eine besondere Aufmerksamkeit beim Patientenkontakt, restriktive Indikationen zu invasiven Techniken oder Applikationen und die Beachtung entsprechender baulicher Voraussetzungen.

Eine medikamentöse Prophylaxe sollte bei erwiesener Evidenz durchgeführt werden.

Milde, unspezifische Symptome sind häufig die einzigen primären Anzeichen einer Infektion, die vor einer Aggravierung frühzeitig präemptiv therapiert werden müssen. Dabei muss man an die besondere Bedeutung von Viren, Pilzen und atypischen Bakterien denken, sodass bereits zu Beginn breit wirksame Kombinationstherapien eingesetzt werden sollten.

Bei Sepsis muss auch die Reduktion der Immunsuppression, begleitet von einer engmaschigen Abstoßungsdiagnostik, erwogen werden.

Immunsuppressiva interagieren besonders mit einer Reihe von Antiinfektiva. Dies muss man vor dem Hintergrund der erheblichen Komorbidität von Intensivpatienten beachten.

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