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Dtsch Med Wochenschr 2018; 143(21): 1525-1531
DOI: 10.1055/s-0042-109253
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© Georg Thieme Verlag KG Stuttgart · New York

Antibiotic Stewardship in der Intensivmedizin

M. Fabian Juzek-Küpper
,
René Fussen
,
Miriam Haverkamp
,
Sebastian Lemmen
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Publication History

Publication Date:
18 October 2018 (online)

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Antibiotic-Stewardship-Programme wollen die Versorgungsqualität mit Antiinfektiva im ambulanten und stationären Bereich optimieren. Ziel sind „beste klinische Behandlungsergebnisse“ mit „Minimierung von Toxizität, […] Resistenzentwicklung und Kosten“ [1]. Dabei bewegt sich das ABS-Team manchmal im Spannungsfeld zwischen ärztlicher Therapiefreiheit und rationalen Überlegungen. Neben Fachwissen ist daher auch Kommunikationskompetenz erforderlich.
 

  • Literatur

  • 1 de With K, Allerberger F, Amann S. et al. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection 2016; 44: 395-439
    CrossrefPubMedGoogle Scholar
  • 2 Bundesamt für Verbraucherschutz und Lebensmittelsicherheit, Paul-Ehrlich-Gesellschaft für Chemotherapie e.V.. (Hrsg). GERMAP 2015 – Bericht über den Antibiotikaverbrauch und die Verbreitung von Antibiotikaresistenzen in der Human- und Veterinärmedizin in Deutschland. Rheinbach: Antiinfectives Intelligence; 2016
    Google Scholar
  • 3 Dalhoff K, Abele-Horn M, Andreas S. et al. Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia – Update 2017 – S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology. Pneumologie 2018; 72: 15-63
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Rhee C. Using procalcitonin to guide antibiotic therapy. Open Forum Infect Dis 2017; 4: ofw249
    PubMedGoogle Scholar
  • 5 Oliveira CF, Botoni FA, Oliveira CRA. et al. Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med 2013; 41: 2336-2343
    CrossrefPubMedGoogle Scholar
  • 6 Azuhata T, Kinoshita K, Kawano D. et al. Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock. Critical Care 2014; 18: R87
    CrossrefPubMedGoogle Scholar
  • 7 Jensen JU, Heslet L, Jensen TH. et al. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Critical Care Medicine 2006; 34: 2596
    CrossrefPubMedGoogle Scholar
  • 8 Jensen JU, Hein L, Lundgren B. et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: A randomized trial. Critical Care Medicine 2011; 39: 2048
    CrossrefPubMedGoogle Scholar
  • 9 Fätkenheuer G, Jung N, Kern WV. et al. Infektiologie – ein Schwerpunkt der Inneren Medizin. Internist 2018; 59: 334-340
    CrossrefPubMedGoogle Scholar
  • 10 Vardakas KZ, Voulgaris GL, Maliaros A. et al. Prolonged versus short-term intravenous infusion of antipseudomonal β-lactams for patients with sepsis: a systematic review and meta-analysis of randomised trials. Lancet Infect Dis 2018; 18: 108-120
    CrossrefPubMedGoogle Scholar
  • 11 Muller AE, Huttner B, Huttner A. Therapeutic drug monitoring of beta-lactams and other antibiotics in the intensive care unit: which agents, which patients and which infections?. Drugs 2018; 78: 439-451
    CrossrefPubMedGoogle Scholar
  • 12 MacFadden DR, LaDelfa A, Leen J. et al. Impact of reported beta-lactam allergy on inpatient outcomes: A multicenter prospective cohort study. Clin Infect Dis 2016; 63: 904-910
    CrossrefPubMedGoogle Scholar
  • 13 Huang KHG, Cluzet V, Hamilton K. et al. The impact of reported beta-lactam allergy in hospitalized patients with hematologic malignancies requiring antibiotics. Clin Infect Dis 2018 [epub ahead of print]
    PubMedGoogle Scholar
  • 14 Davey P, Marwick CA, Scott CL. et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2017; 2: CD003543
    PubMedGoogle Scholar
  • 15 Schuts EC, Hulscher MEJL, Mouton JW. et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis 2016; 16: 847-856
    CrossrefPubMedGoogle Scholar
  • 16 Paulsen J, Solligård E, Damås JK. et al. The impact of infectious disease specialist consultation for Staphylococcus aureus bloodstream infections: A systematic review. Open Forum Infect Dis 2016; 3: ofw048
    CrossrefPubMedGoogle Scholar
  • 17 Baur D, Gladstone BP, Burkert F. et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis 2017; 17: 990-1001
    CrossrefPubMedGoogle Scholar
  • 18 van Duijn PJ, Verbrugghe W, Jorens PG. et al. SATURN consortium. The effects of antibiotic cycling and mixing on antibiotic resistance in intensive care units: a cluster-randomised crossover trial. Lancet Infect Dis 2018; 18: 401-409
    CrossrefPubMedGoogle Scholar
  • 19 Morgan DJ, Malani P, Diekema DJ. Diagnostic stewardship-leveraging the laboratory to improve antimicrobial use. JAMA 2017; 318: 607-608
    CrossrefPubMedGoogle Scholar
  • 20 ARS – Antibiotika Resistenz Surveillance. Im Internet: https://ars.rki.de/ (Stand: 06.06.2018)
    PubMedGoogle Scholar