Antimikrobielle Therapie bei Sepsis – Klinische Rationalen, individuelle Risikoprofile und lokale Resistenzmuster

Der globalen Ausbreitung bakterieller Resistenzen steht eine von Jahr zu Jahr abnehmende Anzahl neuer antiinfektiver Substanzen gegenüber. Vor allem bei der Therapie von Infektionen mit multiresistenten gramnegativen Bakterien (MRGN) sind unsere therapeutischen Möglichkeiten begrenzt. Gerade bei Patienten mit einem lebensbedrohlichen septischen Schock spielt jedoch die von Beginn an adäquate antimikrobielle Therapie eine entscheidende Rolle. Die Notwendigkeit einer schnellen Therapieeinleitung zwingt überdies zu einer initial breiten antibiotischen Therapie, da ein zuverlässiges mikrobiologisches Ergebnis erst im weiteren Krankheitsverlauf vorliegt. Bei Identifizierung des Erregers wird eine konsequente Deeskalation empfohlen, auch wenn es sich hierbei nur um wenige Tage handelt.

The incidence of antibiotic-resistance has been rapidly increasing. At the same time, fewer new antibiotics are being developed. Particularly, in infections due to multi drug resistant gram negative organisms our therapeutic armamentarium is restricted. Adequate therapy is however essential in the treatment of critical ill patients with septic shock. Since credible microbiological results are not available on the first day of treatment broad-spectrum antibiotics have to be used for initial treatment. After identification of the responsible organism consequent deescalation is recommended, even if it is only a matter of a few days.

Key words

Sepsis - antimicrobial therapy - antibiotics - antibiotic-resistance - multi drug resistant gram negative organisms - deescalation

• Literatur

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