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DOI: 10.1055/s-2004-836084
© Georg Thieme Verlag Stuttgart · New York
Antibiotikatherapie der Sepsis[1]
Sepsis management - antibiotic therapyPublication History
eingereicht: 21.10.2004
akzeptiert: 2.11.2004
Publication Date:
19 November 2004 (online)

Zusammenfassung
Die Sepsis ist eine der häufigsten Infektionskrankheiten auf der Intensivstation und geht mit einer substantiellen Sterblichkeit einher. Diese konnte trotz einer Vielzahl verbesserter supportiver Maßnahmen im Bereich der Volumen-, Katecholamin- und endokrinologischen Therapie in den letzten Jahren nicht ausreichend gesenkt werden. Grund hierfür ist, dass der wesentliche Schritt zur erfolgreichen Überwindung der Sepsis in der chirurgischen Herdsanierung liegt, aber Fokussuche nicht mit höhster Konsequenz betrieben wird. Zudem ist die antibiotische Therapie des Infektionsfokus nicht immer optimal, zumal die Resistenzentwicklung der gängigen Antibiotika gegenüber den wichtigsten Infektionserregern zunimmt. Da bis auf Teilbereiche keine wesentliche Neu- und Weiterentwicklung antiinfektiver Substanzen in den nächsten Jahren zu erwarten ist, muss das Hauptaugenmerk auf die Infektionsvermeidung und die Optimierung der antibiotischen Strategien gerichtet werden. Zentral ist daher eine breite, hochdosierte Initialtherapie, eine klinisch orientierte Deeskalationsstrategie und eine - mit Ausnahmen - auf 7 - 10 Tagen begrenzte Therapiedauer. Rotierende Antibiotikastrategien sollten immer dann angestrebt werden, wenn Resistenzprobleme existieren und keine infektiologische Kompetenz auf der Intensivstation vorhanden ist.
Summary
Sepsis is one of the most frequent infectious problems at Intensive Care Units, and sepsis is assocciatad with significant mortality. The latter could not be markedly reduced in the last years, despite a number of advances in the field of volume substitution, catecholamines, and endocrinologic therapy. The reason might be that important steps towards overcoming of sepsis are the surgical resection of infectious foci and an adequate antibiotic treatment. A critical role plays the growing resistance of pathogens against the common antibiotics. Since no major progress in the development of new antibiotics can be expected for the next years, sepsis treatment must be focused on prevention of infection, and on an optimised application of current antibiotic substances. The key factors are a broad and high dose initial treatment, a de-escalation strategy according to the clinical course, and -with exceptions- a limitation of treatment to 7 to 10 days. Rotation of antibiotics should be performed, if problems with resistances exist or no specialist for infectious diseases is available on the Intensive Care Unit.
1 Die Arbeit wurde unterstützt durch das Kompetenznetz Sepsis (SepNet), gefördert vom deutschen Bundesministerium für Bildung und Forschung (Förderkennzeichen: 01 KI 0106)
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1 Die Arbeit wurde unterstützt durch das Kompetenznetz Sepsis (SepNet), gefördert vom deutschen Bundesministerium für Bildung und Forschung (Förderkennzeichen: 01 KI 0106)
Prof. Dr. Tobias Welte
Abteilung Pneumologie, Medizinische Hochschule Hannover
Carl-Neuberg-Straße 1
30625 Hannover
Phone: 0511/5323531
Fax: 0511/5323353
Email: welte.tobias@mh-hannover.de