Therapieoptionen bei Infektion durch nosokomiale multiresistente Erreger

Kernaussagen

• Daptomycin ist zur Behandlung von pulmonalen Infektionen nicht geeignet.

• Linezolid hat eine sehr gute orale Bioverfügbarkeit und kann daher frühzeitig oralisiert werden.

• Tigecyclin ist zur Monotherapie von schweren nosokomialen Infektionen insbesondere bei Bakteriämie nicht geeignet.

• Studien zur MRSA-Pneumonie mit Ceftarolin liegen nicht vor.

• Die Resistenzentwicklung bei gramnegativen Bakterien ist bedrohlich und wird in den nächsten Jahren weiter zu nehmen.

• Bei unkomplizierten Harnwegsinfektionen durch 3- und 4MRGN können in der Regel Alternativen (Nitrofurantoin, Fosfomycin) eingesetzt werden, wenn sie empfindlich getestet sind.

• Bei schweren Infektionen durch 3MRGN ist eine Monotherapie der noch wirksamen Antibiotikagruppe, in der Regel eine Therapie mit einem Carbapenem – unter Umständen auch Piperacillin-Tazobactam, ausreichend.

• Bei schweren Infektionen durch 4MRGN, insbesondere KPC scheint eine Kombinationstherapie (insbesondere eine Dreifachkombination mit Colistin und Carbapenem mit Tigecyclin oder Fosfomycin) vorteilhaft zu sein.

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