Infektionsrisiko und postoperative Wundinfektionen beim geriatrischen Patienten

Zusammenfassung

Zukünftig müssen auf die Versorgung geriatrischer Patienten und die Kenntnisse altersphysiologischer Veränderungen ein besonderes Augenmerk gelegt werden. Infektionen stehen beim älteren Patienten an vierthäufigster Stelle der Todesursachen. Infektionen verlaufen in dieser Patientengruppe meist schwerer als bei jungen Menschen und enden häufiger letal. Die zugrunde liegenden Ursachen sind mannigfaltig; das Immunsystem altert, Malnutrition, alternsphysiologische Funktionseinschränkung der Organe und die durch die geriatrietypische Komorbidität bedingte Polymedikation spielen eine bedeutende Rolle. In diesem Zusammenhang machen postoperative Wundinfektionen rund 17 % der nosokomialen Infektionen aus und treffen 2–5 % der Patienten, die sich einem operativen Eingriff unterzogen haben. Es gibt verschiedene Optionen der Risikokontrolle wie beispielsweise der Erhalt peri- und intraoperativer Normothermie, die Beachtung eines ausgeglichenen Stoffwechsels, insbesondere des Monitorings des Blutzuckerspiegels, die Anwendung von Wärmebehandlung und die frühe Mobilisation des Intensiv patienten. Diese beinhaltet auch die geriatrische Akut -rehabilitation. Die nachhaltige Sicherung des operativen Behandlungserfolges erfordert von allen Beteiligten den interdisziplinären und interprofessionellen Dialog.

Summary

Due to demographic shifts, the number of elderly patients treated for postoperative infections is increasing. Therefore in the future treatment of geriatric patients and knowledge of physiological changes in the elderly must be centered. In older adults infections are one of the most common causes of mortality. In these patients course of infections is more severe and often lethal and surgical site infections occur in about 17 % of all hospital-acquired infections. During the physiologic ageing process, various organ systems are affected that are important for response to infection. Structural and functional changes take place in the organ systems, which modify patients’ immune and defense status and physiologic stress response. Also the number of chronic conditions increases with increasing age; on average, 3 to 9 concomitant conditions (diabetes mellitus, arterial hypertension, osteoporosis, incontinence, chronic bronchitis, heart failure, impairment of cognitive performance, etc.) are to be expected, which inevitably increases the risk of complications and, partially as a result, morbidity and mortality from most infectious diseases increase with ascending age. The most prominent comorbidities triggering infections are diabetes mellitus and chronic heart failure. There are various options to minimize the risk of peri- and postoperative infections such as keeping normothermia, tight monitoring of bloodglucose levels, the use of heat treatment and early mobilisation of critically ill patients. This also includes an early acute geriatric rehabilitation. To ensure success of treatment the interdiciplinary and interprofessional dialogue is essential.

Schlüsselwörter

Geriatrie - Infektionsprävention - Wundinfektion

Keywords

Geriatrics - prevention of infection - surgical site infections

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