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Zentralbl Chir 2012; 137(3): 274-278
DOI: 10.1055/s-0031-1284043
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Neue Erkenntnisse zur Sepsis durch bakterielle Translokation

Current Aspects of Sepsis Caused by Bacterial Translocation
G. Lamprecht
1   Universitätsklinik Tübingen, Medizinische Klinik, Abt. I
,
A. Heininger
2   Universitätsklinik Tübingen, Universitätsklinik für Anästhesiologie und Intensivmedizin
› Author Affiliations
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Publication History

Publication Date:
18 June 2012 (online)

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Zusammenfassung

Bakterielle Translokation als Ursache einer Sepsis ohne fassbaren Fokus ist ein lange bekanntes Konzept, das bisher beim Menschen schwer beweisbar war. Störungen der intestinalen Barriere als komplexes Zusammenspiel physikalischer, biochemischer und immunologischer Faktoren sind hierfür die pathophysiologische Voraussetzung. Neue Befunde legen nahe, dass dieses Konzept um die Möglichkeit der Translokation von Bestandteilen von Bakterien (pathogen associated molecular patterns, PAMPs) erweitert werden muss. Dies schließt nicht aus, dass beide Mechanismen der Stimulation proinflammatorischer Kaskaden mit nachfolgender septischer Reaktion auftreten können. Molekulare Nachweismethoden für Bakterien und deren Bestandteile versuchen diesem erweiterten Konzept in der Diagnostik Rechnung zu tragen, haben aber noch keinen Einzug in die Routine erlangt. Eine spezifische therapeutische Intervention an den Sepsis-triggernden Signalwegen des angeborenen und des spezifischen Immunsystems in der Darmmukosa hat sich bisher nicht ergeben. Selective oral decontamination (SOD) und selective digestive tract decontamination (SDD) sind wirksame prophylaktische Maßnahmen gegen nosokomiale septische Komplikationen. Ein kausaler Zusammenhang mit der Zunahme resistenter Erreger ist hierunter bisher nicht beobachtet worden. Der Einsatz von Probiotika als Prophylaxe gegen septische Komplikationen ist kontrovers und hat in einzelnen Studien zu einer Verschlechterung der Prognose geführt.

Abstract

Bacterial translocation has been put forward as a concept to explain sepsis without an infectious focus, but it has been difficult to prove in humans. Dysfunction of the intestinal barrier, which is composed of physical, biochemical and immunological factors, is the pathophysiological prerequisite for bacterial translocation. Recent findings indicate that not only viable bacteria but also pathogen associated molecular patterns may translocate and cause sepsis. Molecular detection methods for bacteria or their components have been developed to address these new concepts, but they have not yet become widely available. Specific therapeutic interventions within the sepsis cascades and signaling pathways of the innate and specific immune system so far have not been successful. Selective oral decontamination (SOD) und selective digestive tract decontamination (SDD) are efficacious prophylactic measures against nosocomial septic complications. An increased incidence of resistant pathogens has not been encountered. The use of probiotics as prophylaxis against septic complications is controversial and has led in some studies to a worse prognosis.

Schlüsselwörter

Sepsis - bakterielle Translokation - intestinale Barriere - pathogen associated molecular patterns

Key words

sepsis - bacterial translocation - intestinal barrier - pathogen associated molecular patterns
 

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