Gastroenterologie up2date, Table of Contents Gastroenterologie up2date 2025; 21(02): 173-195DOI: 10.1055/a-2408-4764 Infektiologie Gastrointestinale Infektionen Christoph Lübbert , Sebastian Wendt Recommend Article Abstract Buy Article All articles of this category Mit einer Schleimhautoberfläche von 250–400 m2 ist der Gastrointestinaltrakt die größte Kontaktfläche zwischen dem Körper und körperfremden Substanzen [1]. Dies führt unweigerlich zu einem Kontakt mit potenziell pathogenen Erregern oder Toxinen. Der folgende Beitrag stellt die verschiedenen Erreger vor und gibt einen Überblick über die Diagnose und Therapie der entsprechenden Krankheitsbilder. Schlüsselwörter SchlüsselwörterInfektionen - gastrointestinal - Diarrhö - orale Rehydratation - Stuhlprobe - Antibiotika - Therapie Full Text References Literatur 1 Lübbert C, Mutters R. Gastrointestinale Infektionen. Internist 2017; 58: 149-169 2 Lankisch PG, Mahlke R, Lübbers H. et al. Leitsymptom Diarrhoe. Dtsch Arztebl Ausg A 2006; 103: A261-269 3 World Health Organization. Diarrhoeal disease. Accessed April 12, 2025 at: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease 4 Wilking H, Spitznagel H, Werber D. et al. Acute gastrointestinal illness in adults in Germany: a population-based telephone survey. Epidemiol Infect 2013; 141: 2365-2375 5 Lynen-Jansen P, Stallmach A, Lohse AW. et al. [Development of gastrointestinal infectious diseases between 2000 and 2012]. Z Gastroenterol 2014; 52: 549-557 6 Brestrich G, Angulo FJ, Berger FK. et al. Epidemiology of Clostridioides difficile Infections in Germany, 2010–2019: A Review from Four Public Databases. Infect Dis Ther 2023; 12: 1057-1072 7 Robert Koch-Institut. SurvStat@rki 2.0. Web-basierte Abfrage der Meldedaten gemäß Infektionsschutzgesetz (IfSG). Accessed April 12, 2025 at: https://survstat.rki.de/ 8 Hagel S, Stallmach A, Lohse AW. Diagnostik und Therapie infektiöser Durchfallerkrankungen. Was ist gesichert?. Internist 2015; 56: 1353-1360 9 Siegel DL, Edelstein PH, Nachamkin I. Inappropriate testing for diarrheal diseases in the hospital. JAMA 1990; 263: 979-982 10 Manthey CF, Epple HJ, Keller KM. et al. S2k-Leitlinie Gastrointestinale Infektionen der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 2024; 62: 1090-1149 11 Valenstein P, Pfaller M, Yungbluth M. The use and abuse of routine stool microbiology: a College of American Pathologists Q-probes study of 601 institutions. Arch Pathol Lab Med 1996; 120: 206-211 12 van Prehn J, Vandenbroucke-Grauls CM, van Beurden YH. et al. Diagnostic yield of repeat sampling with immunoassay, real-time PCR, and toxigenic culture for the detection of toxigenic Clostridium difficile in an epidemic and a non-epidemic setting. Eur J Clin Microbiol Infect Dis 2015; 34: 2325-2330 13 Yasmin N, Ruzante JM, Barkley JA. et al. Detection of gastrointestinal pathogens in stool samples using a rapid multiplex PCR test at a large tertiary pediatric hospital. Diagn Microbiol Infect Dis 2024; 110: 116544 14 Babb C, Badji H, Bhuiyan MTR. et al. Evaluation of Fecal Inflammatory Biomarkers to Identify Bacterial Diarrhea Episodes: Systematic Review and Protocol for the Enterics for Global Health Shigella Surveillance Study. Open Forum Infect Dis 2024; 11 (Suppl. 1) S65-S75 15 Ágreda Fernández M, Origüen J, Rodriguez-Goncer I. et al. Predictive value of fecal calprotectin and lactoferrin levels for negative outcomes in Clostridioides difficile infection. Eur J Clin Microbiol Infect Dis 2024; 43: 313-324 16 Lübbert C. Antimicrobial therapy of acute diarrhoea: a clinical review. Expert Rev Anti Infect Ther 2016; 14: 193-206 17 Steffen R, Hill DR, DuPont HL. Traveler’s diarrhea: a clinical review. JAMA 2015; 313: 71-80 18 Thielman NM, Guerrant Rl. Clinical practice: Acute infectious diarrhea. N Engl J Med 2004; 350: 38-47 19 Wistrom J, Jertborn M, Ekwall E. et al. Empiric treatment of acute diarrheal disease with norfloxacin. A randomized, placebo-controlled study. Swedish Study Group. Ann Intern Med 1992; 117: 202-208 20 Mutters R, Walger P, Lübbert C. Calculated initial parenteral treatment of bacterial infections: Bacterial gastrointestinal infections. GMS Infect Dis 2020; 8: Doc06 21 Riddle MS, Connor BA, Beeching NJ. et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J Travel Med 2017; 24 (Suppl. 1) S57-S74 22 Dabbousi AA, Osman M, Dabboussi F, Hamze M. High rates of macrolide and fluoroquinolone resistance in human campylobacteriosis in the Middle East and North Africa. Future Microbiol 2022; 17: 957-967 23 Flynn TG, Olortegui MP, Kosek MN. Viral gastroenteritis. Lancet 2024; 403: 862-876 24 Hönemann M, Liebert UG. Virale Gastroenteritiden. In: Lübbert C, Vogelmann R. , Hrsg. Gastroenterologische Infektiologie. Berlin: Walter de Gruyter; 2017 25 Robilotti E, Deresinski S, Pinsky BA. Norovirus. Clin Microbiol Rev 2015; 28: 134-164 26 van Beek J, van der Eijk AA, Fraaij PL. et al. Chronic norovirus infection among solid organ recipients in a tertiary care hospital, the Netherlands, 2006–2014. Clin Microbiol Infect 2017; 23: 265.e9-265.e13 27 Dennehy PH. Rotavirus Infection: A Disease of the Past?. Infect Dis Clin North Am 2015; 29: 617-635 28 European Centre for Disease Prevention and Control. Salmonellosis. In: ECDC. Annual Epidemiological Report for 2022. Stockholm: ECDC; 2024. Accessed April 12, 2025 at: https://www.ecdc.europa.eu/en/publications-data/salmonellosis-annual-epidemiological-report-2022 29 Onwuezobe IA, Oshun PO, Odigwe CC. Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. Cochrane Database Syst Rev 2012; (11) CD001167 30 Robert Koch-Institut. Salmonellose. Ratgeber für Ärzte. Accessed April 12, 2025 at: https://www.rki.de/DE/Aktuelles/Publikationen/RKI-Ratgeber/Ratgeber/Ratgeber_Salmonellose.html 31 Trawinski H, Wendt S, Lippmann N. et al. Typhus abdominalis und Paratyphus. Z Gastroenterol 2020; 58: 160-170 32 Wain J, Hendriksen RS, Mikoleit ML. et al. Typhoid fever. Lancet 2015; 385: 1136-1145 33 European Centre for Disease Prevention and Control. Shigellosis. In: ECDC. Annual Epidemiological Report for 2022. Stockholm: ECDC; 2024. Accessed April 12, 2025 at: https://www.ecdc.europa.eu/en/publications-data/shigellosis-annual-epidemiological-report-2022 34 Christopher PR, David KV, John SM. et al. Antibiotic therapy for Shigella dysentery. Cochrane Database Syst Rev 2010; (08) CD006784 35 European Centre for Disease Prevention and Control. Campylobacteriosis. In: ECDC. Annual Epidemiological Report for 2022. Stockholm: ECDC; 2024. Accessed April 12, 2025 at: https://www.ecdc.europa.eu/en/publications-data/campylobacteriosis-annual-epidemiological-report-2022 36 Robert Koch-Institut (RKI). Campylobacter-Infektionen. Ratgeber für Ärzte. Accessed April 12, 2025 at: https://www.rki.de/DE/Themen/Infektionskrankheiten/Infektionskrankheiten-A-Z/C/Campylobacter/campylobacter-node.html 37 Lehtopolku M, Kotilainen P, Haanpera-Heikkinen M. et al. Ribosomal mutations as the main cause of macrolide resistance in Campylobacter jejuni and Campylobacter coli. Antimicrob Agents Chemother 2011; 55: 5939-5941 38 Sasse M, Reinhardt F, Lübbert C. Reisediarrhö. Reisemedizin up2date 2024; 1: 33-49 39 Buchholz U, Bernard H, Werber D. et al. German outbreak of Escherichia coli O104:H4 associated with sprouts. N Engl J Med 2011; 365: 1763-1770 40 Smith KE, Wilker PR, Reiter PL. et al. Antibiotic treatment of Escherichia coli O157 infection and the risk of hemolytic uremic syndrome, Minnesota. Pediatr Infect Dis J 2012; 31: 37-41 41 Menne J, Nitschke M, Stingele R. et al. Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study. BMJ 2012; 345: e4565 42 Nitschke M, Sayk F, Hartel C. et al. Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4. JAMA 2012; 307: 1046-1052 43 European Centre for Disease Prevention and Control. Yersiniosis. In: ECDC. Annual Epidemiological Report for 2022. Stockholm: ECDC; 2024. Accessed April 12, 2025 at: https://www.ecdc.europa.eu/en/publications-data/yersiniosis-annual-epidemiological-report-2022 44 Cover TL, Aber RC. Yersinia enterocolitica. N Engl J Med 1989; 321: 16-24 45 European Centre for Disease Prevention and Control. Listeriosis. In: ECDC. Annual Epidemiological Report for 2022. Stockholm: ECDC; 2024. Accessed April 12, 2025 at: https://www.ecdc.europa.eu/en/publications-data/listeriosis-annual-epidemiological-report-2022 46 Hof H. An update on the medical management of listeriosis. Expert Opin Pharmacother 2004; 5: 1727-1735 47 Sutter JP, Kocheise L, Kempski J. et al. Gentamicin combination treatment is associated with lower mortality in patients with invasive listeriosis: a retrospective analysis. Infection 2024; 52: 1601-1606 48 Harris JB, Larocque RC, Qadri F. et al. Cholera. Lancet 2012; 379: 2466-2476 49 Lübbert C, John E, von Müller L. Clostridium difficile-Infection (CDI): Guideline-based diagnosis and treatment. Dtsch Arztebl Int 2014; 111: 723-731 50 Van Prehn J, Reigadas E, Vogelzang EH. et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clin Microbiol Infect 2021; 27 (Suppl. 2) S1-S21 51 Louie TJ, Miller MA, Mullane KM. et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011; 364: 422-431 52 Guery B, Menichetti F, Anttila VK. et al. Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND): a randomised, controlled, open-label, phase 3b/4 trial. Lancet Infect Dis 2018; 18: 296-307 53 Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev 2010; (10) CD003048 54 Lübbert C, Salzberger B, Mössner J. Fäkaler Mikrobiomtransfer. Internist 2017; 58: 456-468 55 Youngster I, Russell GH, Pindar C. et al. Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection. JAMA 2014; 312: 1772-1778 56 van Nood E, Vrieze A, Nieuwdorp M. et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013; 368: 407-415 57 Fischer M, Sipe B, Cheng YW. et al. Fecal microbiota transplant in severe and severe-complicated Clostridium difficile: A promising treatment approach. Gut Microbes 2017; 8: 289-302 58 Feuerstadt P, Louie TJ, Lashner B. et al. SER-109, an Oral Microbiome Therapy for Recurrent Clostridioides difficile Infection. N Engl J Med 2022; 386: 220-229 59 Feuerstadt P, Chopra T, Knapple W. et al. PUNCH CD3-OLS: a phase 3 prospective observational cohort study to evaluate the safety and efficacy of fecal microbiota, live-jslm (REBYOTA) in adults with recurrent Clostridioides difficile infection. Clin Infect Dis 2024; 80: 43-51 60 Wright SG. Protozoan infections of the gastrointestinal tract. Infect Dis Clin North Am 2012; 26: 323-339 61 Schneider A, Wendt S, Lübbert C. et al. Current pharmacotherapy of cryptosporidiosis: an update of the state-of-the-art. Expert Opin Pharmacother 2021; 22: 2337-2342 62 Abubakar I, Aliyu SH, Arumugam C. et al. Prevention and treatment of cryptosporidiosis in immunocompromised patients. Cochrane Database Syst Rev 2007; (01) CD004932 63 European Centre for Disease Prevention and Control. Giardiasis. In: ECDC. Annual Epidemiological Report for 2022. Stockholm: ECDC; 2024. Accessed April 12, 2025 at: https://www.ecdc.europa.eu/en/publications-data/giardiasis-annual-epidemiological-report-2022 64 Granados CE, Reveiz L, Uribe LG. et al. Drugs for treating giardiasis. Cochrane Database Syst Rev 2012; (12) CD007787 65 Lalle M. Giardiasis in the post genomic era: treatment, drug resistance and novel therapeutic perspectives. Infect Disord Drug Targets 2010; 10: 283-294 66 Bourque DL, Neumayr A, Libman M. et al. Treatment strategies for nitroimidazole-refractory giardiasis: a systematic review. J Travel Med 2022; 29: taab120 67 Haque R, Huston CD, Hughes M. et al. Amebiasis. N Engl J Med 2003; 348: 1565-1573 68 Kantele A, Lääveri T, Mero S. et al. Antimicrobials increase travelers’ risk of colonization by extended-spectrum beta-lactamase producing Enterobacteriaceae. Clin Infect Dis 2015; 60: 837-846 69 Lübbert C, Straube L, Stein C. et al. Colonization with extended-spectrum beta-lactamase (ESBL)-producing and carbapenemase-producing Enterobacteriaceae in international travelers returning to Germany. Int J Med Microbiol 2015; 305: 148-156