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Zentralblatt für Kinderchirurgie 2002; 11(2): 59-71
DOI: 10.1055/s-2002-30151
Leitartikel

© Georg Thieme Verlag Stuttgart · New York

Antibiotikaeinsatz in der Kinderchirurgie

Bewährtes und NeuesAntibiotic Therapy in Paediatric SurgeryWell Proven and InnovativeM. Aulmann1 , G. Benz2
  • 1Klinische Laboratorien und Blutbank und
  • 2Kinderchirurgische Abteilung, Chirurgischen Universitätsklinik Heidelberg
Herrn Prof. Dr. K. L. Waag zum 60. Geburtstag gewidmet
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Publication History

Publication Date:
16 May 2002 (online)

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Zusammenfassung

Die mikrobiologischen Befunde der kinderchirurgischen Abteilung der Chirurgischen Universitätsklinik in Heidelberg im Vergleich mit denen anderer Abteilungen der Klinik aus den Jahren 1993 bis 1998 ergeben erfreulicherweise keine Hinweise für den leichtfertigen Einsatz von Antibiotika. Eine antibiotische Behandlung erfolgt im Klinikum möglichst gezielt nach Keimdiagnostik und Empfindlichkeitstestung. Zur Durchführung einer empirischen Therapie sind für die Wahl eines geeigneten Antibiotikums der Ort des Infektionsgeschehens, die Herkunft der vermuteten Erreger (nosokomial, ambulant), die Resistenzentwicklung in der Klinik sowie die Phamakokinetik des Antibiotikums zu berücksichtigen. Die perioperative Antibiotikaprophylaxe wird unter der Berücksichtigung der Wundklassifikationen - sauber, sauber kontaminiert und kontaminiert schmutzig - durchgeführt. Bei Operationen, deren Wunden als „sauber kontaminiert” oder „kontaminiert schmutzig” eingestuft werden, wird eine Antibiotikaprophylaxe in der Regel vorgesehen. Als Antibiotika werden bevorzugt Cephalosporine der 1. oder 2. Generation empfohlen, die bei möglichen anaeroben Begleitkeimen mit Metronidazol kombiniert werden. Für Operationen mit einer Dauer von bis zu 2-3 Stunden genügt eine einzige Antibiotikagabe in ausreichend hoher Dosierung. Bei Operationen mit längerer Dauer oder einem erhöhten Blutverlust sind weitere Gaben intra operationem notwendig, um ausreichende Antibiotika-Serumspiegel bis zum Operationsende zu gewährleisten. Die Weiterführung einer Antibiotikaprophylaxe nach Operationsende sollte dann als empirisch geführte Antibiotikatherapie möglichst schnell durch eine gezielte Therapie ersetzt werden. Für die allgemeine Reduktion von Wundinfektionen ergibt sich aus einer antibiotischen eher unreflektierten Kurzzeit-Therapie kein Benefit.

Abstract

A comparison of the microbiological analyses of the paediatric surgery department with the Heidelberg University surgical hospital does not show an increase of indiscriminate use of antibiotics. In Heidelberg, the application of antimicrobial chemotherapy is strictly based on prior bacteria identification. Infection and the success of antibiotic therapy are monitored by frequent laboratory analysis. The chosen empirical therapy should be based on the location of the infection, the probable origin of the bacteria (nosocomial or otherwise), the specific resistances observed in prior nosocomial infections as well as in infections originating outside the hospital and the pharmacokinetics of the antibiotic used. Perioperative antimicrobial prophylaxis is applied according to wound classification (clean, potentially contaminated, contaminated). As a rule, prophylaxis is limited to the surgical treatment of wounds classified as contaminated or potentially contaminated. The preferred chemotherapeutics are first or second generation cephalosporins which can be combined with metronidazole if an anaerobic infection is suspected. If surgery does not exceed 2-3 hours a single adequate dose is sufficient.  Further intra operative applications are necessary if surgery takes more time or if a considerable loss of blood occurs. In this case constant serum levels of the antiinfectious chemotherapeutics must be maintained. It should only be carried out as empirical therapy until it can be substituted by a resistance adapted treatment. A prolonged antimicrobial prophylaxis amounting to an indiscriminate short time therapy provides no benefits in reducing wound infections and their complications.

Schlüsselwörter

β-Lactam-Antibiotika-Pharmakokinetik - Resistenzen - Antibiotikaprophylaxe - Kinderchirurgie

Key words

β-lactam-antibiotics-pharmakokinetic - Resistance - Prophylactic application - Pediatric surgery

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Prof. Dr. Gert Benz

Kinderchirurgische Abteilung

Chirurgische Universitätsklinik

Im Neuenheimer Feld 110

69120 Heidelberg

Phone: 0 62 21/56-61 19

Fax: 0 62 21/56-58 58

Email: gert_benz@med.uni-heidelberg.de

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