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Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(04): 248-259
DOI: 10.1055/s-0042-122129
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CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Antibiotic Stewardship und Hygiene – 2 Seiten einer Medaille

Antibiotic Stewardship and Infection Control – Two Pages of a Coin
Petra Gastmeier
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Publication History

Publication Date:
03 May 2017 (online)

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Zusammenfassung

In der öffentlichen Wahrnehmung werden hohe Raten von multiresistenten Erregern in medizinischen Einrichtungen vor allem mit zwei Begriffen assoziiert: erstens „Krankenhaus“ und zweitens „Hygieneproblem“. Wahrscheinlich mindestens ebenso wichtig oder sogar wichtiger ist jedoch der Antibiotikaeinsatz im ambulanten und stationären Bereich. Antibiotika selektionieren multiresistente Erreger (MRE). Durch die Mikrobiomforschung werden wir diese Zusammenhänge in der Zukunft besser verstehen. Wahrscheinlich bieten sich dadurch auch neue Ansatzpunkte für die Prävention der Ausbreitung von multiresistenten Erregern. Die vorliegenden Daten unterstreichen die Notwendigkeit der engen Interaktion zwischen Krankenhaushygiene und einer rationalen Antiinfektiva-Verordnung (Antibiotic Stewardship).

Lange Zeit wurde versucht, die hohen Raten an multiresistenten Erregern (MRE) in medizinischen Einrichtungen durch immer strengere Hygienemaßnahmen zu bekämpfen. Aber mittlerweile ist klar: Mindestens ebenso wichtig ist der Antibiotikaeinsatz, denn Antibiotika selektionieren MRE. Dieser Beitrag erläutert die aktuelle Studienlage und unterstreicht: Nur durch Antibiotic Stewardship und Hygiene zusammen ist eine Reduktion der MRE zu erreichen.

Abstract

According to public awareness, high rates of multiresistant organisms in healthcare facilities are mainly associated with two terms: “Hospital” and “Infection control problem”. The use of antibiotics in ambulatory and hospital care is probable at least as important or even more important. Antibiotics lead to selection of multiresistant organisms. Microbiome research will lead to a better understanding of this relationship and may provide new measures for preventing the spread of multiresistant organisms. The available data underline the need of a close interaction between antibiotic stewardship and infection control.

Kernaussagen

  • Im Krankenhaus sind Patienten häufiger gegenüber Antibiotika exponiert als gegenüber Patienten, die mit multiresistenten Erregern (MRE) kolonisiert sind.

  • Die Anwendung von Antibiotika bei Patienten führt durch verschiedene Mechanismen zu einem signifikant erhöhten Risiko, dass die Patienten MRE erwerben bzw. diese bei ihnen nachzuweisen sind.

  • Durch Antibiotika-Stewardship-Interventionen ist es möglich, die nosokomialen Erwerbsraten zu reduzieren.

  • Der Zusammenhang zwischen Antibiotikaanwendung und Clostridium-difficile-Infektionen (CDI) ist eindeutig gegeben.

  • Der Interventionseffekt von Antibiotic Stewardship (ABS) auf die nosokomialen CDI-Raten ist nachgewiesen.

  • In den verschiedenen Interventionsstudien wurden unterschiedliche Stewardship-Methoden eingesetzt, sodass bisher noch unklar ist, welche ABS-Maßnahmen den größten Effekt haben.

  • Es ist notwendig, auch im ambulanten Bereich die Anwendung von Antibiotika zu reduzieren.

  • Das Konzept der Isolierung von Patienten mit MRE stammt aus einer Zeit, als die Präventionsmaßnahmen durch rationale Überlegungen begründet wurden.

  • Die Evidenz für die Effektivität der Isolierungsmaßnahmen ist begrenzt und resultiert überwiegend aus Studien, bei denen verschiedene Präventionsmaßnahmen zugleich eingesetzt wurden.

  • Die Mikrobiomforschung wird unser Wissen zur Entwicklung und Verbreitung von MRE in den kommenden Jahren mit Sicherheit deutlich erweitern.

Schlüsselwörter

Antibiotic Stewardship - Hygiene - multiresistente Erreger

Key words

antibiotic stewardship - infection control - multiresistant organisms
 

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