Kernaussagen
Die perioperative Antibiotikaprophylaxe (PAP) bei zahlreichen
Operationen in den Kategorien „sauber”,
„sauber-kontaminiert” und ganz besonders
„kontaminiert” gehört inzwischen zu den gesicherten
Maßnahmen zur Prävention postoperativer Wundinfektionen. Es ist
nicht Aufgabe der PAP, andere nosokomiale Infektionen, z. B. Pneumonien
und Harnwegsinfektionen, zu verhüten.
Das ausgewählte Antibiotikum soll parenteral innerhalb von
60 Minuten vor Operationsbeginn und nicht länger als über 24 Stunden
verabreicht werden.
Zu den bewährten Wirkstoffen zählen die einander
gleichwertigen Erst- und Zweitgenerationscephalosporine (Cefazolin und
Cefuroxim), die bei Operationen im Bauchraum durch Metronidazol ergänzt
werden. Alternativpräparate in der Abdominalchirurgie sind
Aminopenicilline plus Beta-Laktamaseinhibitoren. Für einige Fälle
bieten sich auch Clindamycin und Glykopeptidantibiotika (Vancomycin,
Teicoplanin) an. Ihr Einsatz bleibt jedoch besonderen Situationen (z. B.
Penicillin-/Cephalosporinallergie oder nachweisliche Kolonisation des Patienten
mit einem multiresistenten Staphylococcus aureus-Stamm) vorbehalten. Ein
breiter Einsatz der Glykopeptidantibiotika verbietet sich auch weiterhin trotz
einer deutlichen Zunahme von gegen Oxacillin resistenten Staphylococcus
aureus-Stämmen in zahlreichen chirurgischen Zentren wegen der
begründeten Gefahr, gegen diese Wirkstoffklasse resistente Enterokokken
und Staphylokokken zu selektieren. Zudem haben sich weder Clindamycin noch
Vancomycin bzw. Teicoplanin gegenüber den älteren Cephalosporinen in
der perioperativen Antibiotikaprophylaxe als überlegen erwiesen. Sie
verhindern nicht mehr postoperative Wundinfektionen als die empfohlenen
Cephalosporinantibiotika.
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Dr. med. Lutz Thomas
Institut für Medizinische Mikrobiologie und
Krankenhaushygiene
Heinrich-Heine-Universität
Gebäude 22.21
Moorenstr. 5
40225
Düsseldorf
Email: Lutz.Thomas@uni-duesseldorf.de
