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Aktuelle Urol 2016; 47(03): 229-236
DOI: 10.1055/s-0042-101844
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Hygiene, Screening und Management multiresistenter Erreger (3MRGN, 4 MRGN, MRSA) in der Urologie

Hygiene, Screening and Management of Multidrug-Resistant Pathogens (3MRGN, 4 MRGN, MRSA) in Urology
H.-J. Knopf
1   Klinik für Urologie & Kinderurologie, St. Ansgar Krankenhaus Höxter
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Publication History

Publication Date:
07 April 2016 (online)

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Zusammenfassung

Die zunehmende Resistenzentwicklung gegenüber Antibiotika hat fatale Folgen für die Behandlung von Infektionskrankheiten. Eine der Hauptursachen ist nicht indizierte und damit zu häufige Anwendung dieser Substanzen. Multiresistente Erreger stellen somit heute Einrichtungen des Gesundheitssystems (insbesondere Krankenhäuser) vor große Probleme. Von besonderem Interesse sind Methicillin-resistente S. aureus sowie multiresistente gram-negative Stäbchen. Angepasste Hygienemaßnahmen, ein wirksames Screening sowie eine funktionierendes Management im Umgang mit den betroffenen Patienten sind erforderlich, um das Infektionsrisiko für Patienten und Personal und damit die Ausbreitung der Erreger zu verringern.

Summary

The increasing development of resistance to antibiotics has fatal consequences for the treatment of infectious diseases. One of the main causes is the inappropriate use, and therefore overuse, of these substances. Today, multidrug-resistant pathogens are a major problem for facilities of the public health system, especially for hospitals. Pathogens of particular interest are methicillin-resistant S. aureus and multidrug-resistant gram-negative bacteria. Adapted hygienic measures, effective screening and functioning management of affected patients are required to reduce the risk of infection for patients and staff as well as the spread of pathogens.

Schlüsselwörter

multiresistente Erreger - Hygienemaßnahmen - Screening - Management - Urologie

Key words

multidrug-resistant pathogens - hygienic measures - screening - management - urology
 

  • Literatur

  • 1 Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsbl 2012; 55: 1311-1354
    CrossrefPubMedGoogle Scholar
  • 2 Kresken M. Antibiotikaverbrauch in der Humanmedizin. Bad Honnef-Symposium 2014;
    PubMedGoogle Scholar
  • 3 Bundesamt für Verbraucherschutz und Lebensmittelsicherheit. Antibiotikaabgabe in der Tiermedizin sinkt weiter. Im Internet: http://www.bvl.bund.de/DE/08_PresseInfothek/01_FuerJournalisten/01_Presse_und_Hintergrundinformatioen/05_Tierarzneimittel/2015/2015_07_28_pi_Antibiotikaabgabemenge2014.html?nn=1401276 Stand: 15.2.2016
    PubMedGoogle Scholar
  • 4 Magistro G, Gratzke C, Stief CG et al. Management multiresistenter Erreger in der Urologie. Der Urologe 2015; 54: 267-274
    CrossrefPubMedGoogle Scholar
  • 5 van Belkum A, Verkaik NJ, de Vogel CP et al. Reclassification of Staphylococcus aureus nasal carriage types. J Infect Dis 2009; 199: 1820-1826
    CrossrefPubMedGoogle Scholar
  • 6 Empfehlungen zur Prävention und Kontrolle von Methicillinresistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsbl 2014; 57: 696-732
    PubMedGoogle Scholar
  • 7 Paul-Ehrlich-Gesellschaft für Chemotherapie e.V., Infektiologie Freiburg (Hrsg.) GERMAP 2010 Antibiotika-Resistenz und –Verbrauch. Bericht über den Antibiotikaverbrauch und die Verbreitung von Antibiotikaresistenzen in der Human- und Veterinärmedizin in Deutschland. Bundesamt für Verbraucherschutz und Lebensmittelsicherheit. Rheinbach: Antiinfectives Intelligence Gesellschaft für klinisch-mikrobiologische Forschung und Kommunikation mbH; 2011
    Google Scholar
  • 8 Hanberger H, Walther S, Leone M et al. Increased mortality associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in the intensive care unit: results from the EPIC II study. Int J Antimicrob Agents 2011; 38: 331-335
    CrossrefPubMedGoogle Scholar
  • 9 Cosgrove SE, Sakoulas G, Perencevich EN et al. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003; 36: 53-59
    CrossrefPubMedGoogle Scholar
  • 10 Whitby M, McLaws ML, Berry G. Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 2001; 175: 264-267
    PubMedGoogle Scholar
  • 11 Layer F, Werner G. Eigenschaften, Häufigkeit und Verbreitung von MRSA in Deutschland – Update 2011/2012. Epidemiol Bull 2013; 21: 187-193
    PubMedGoogle Scholar
  • 12 von Eiff C, Becker K, Machka K et al. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 2001; 344: 11-16
    CrossrefPubMedGoogle Scholar
  • 13 Lai KK, Fontecchio S, Melvin Z et al. Impact of alcohol-based, waterless hand antiseptic on the incidence of infection and colonization with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2006; 27: 1018-1024
    CrossrefPubMedGoogle Scholar
  • 14 Sherertz RJ, Bassetti S, Bassetti-Wyss B. „Cloud“ health-care workers. Emerg Infect Dis 2001; 7: 241-244
    CrossrefPubMedGoogle Scholar
  • 15 Dancer SJ. Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008; 8: 101-113
    CrossrefPubMedGoogle Scholar
  • 16 Gastmeier P, Schwab F, Geffers C et al. To isolate or not to isolate? Analysis of data from the German nosocomial infection surveillance system regarding the placement of patients with methicillin-resistant Staphylococcus aureus in private rooms in intensive care units. Infect Control Hosp Epidemiol 2004; 25: 109-113
    CrossrefPubMedGoogle Scholar
  • 17 Harbarth S, Masuet-Aumatell C, Schrenzel J et al. Evaluation of rapid screening and preemptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care (London England) 2006; 10: R25
    CrossrefPubMedGoogle Scholar
  • 18 Curran ET, Hamilton K, Monaghan A et al. Use of a temporary cohort ward as part of an intervention to reduce the incidence of methicillin- resistant Staphylococcus aureus in a vascular surgery ward. J Hosp Infect 2006; 63: 374-379
    CrossrefPubMedGoogle Scholar
  • 19 Kabbani D, Weir SK, Berg G et al. Cohorting based on nasal methicillin-resistant Staphylococcus aureus status: an opportunity to share more than a room. Am J Infect Control 2013; 41: 401-404
    CrossrefPubMedGoogle Scholar
  • 20 Pittet D, Hugonnet S, Harbarth S et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000; 356: 1307-1312
    CrossrefPubMedGoogle Scholar
  • 21 Lucet JC, Paoletti X, Lolom I et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005; 31: 1051-1057
    CrossrefPubMedGoogle Scholar
  • 22 Vos MC, Behrendt MD, Melles DC et al. 5 years of experience implementing a methicillinresistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands. Infect Control Hosp Epidemiol 2009; 30: 977-984
    CrossrefPubMedGoogle Scholar
  • 23 Chaberny IF, Bindseil A, Sohr D et al. A point- prevalence study for MRSA in a German university hospital to identify patients at risk and to evaluate an established admission screening procedure. Infection 2008; 36: 526-532
    CrossrefPubMedGoogle Scholar
  • 24 Mertz D, Frei R, Jaussi B et al. Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus. Clin Infect Dis 2007; 45: 475-477
    CrossrefPubMedGoogle Scholar
  • 25 Köck R, Werner P, Friedrich A et al. Characteristics of Staphylococcus aureus nasal carriage, resistance patterns and genetic lineages in healthy german adults. In 52nd interscience conference on antimicrobial agents and chemotherapy, San Francisco, USA. Washington: American Society for Microbiology; 2012
    Google Scholar
  • 26 Kaminski A, Kammler J, Wick M et al. Transmission of methicillin-resistant Staphylococcus aureus among hospital staff in a German trauma centre: a problem without a current solution?. J Bone Joint Surg Br 2007; 89: 642-645
    PubMedGoogle Scholar
  • 27 Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother 1995; 39: 1211-1233
    CrossrefPubMedGoogle Scholar
  • 28 Queenan AM, Bush K. Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev 2007; 20: 440-458
    CrossrefPubMedGoogle Scholar
  • 29 Mattner F, Bange FC, Meyer E et al. Prävention der Ausbreitung von multiresistenten gramnegativen Erregern. Dtsch Artzebl 2012; 109: 39-45
    PubMedGoogle Scholar