DGI:ZNS-Infektionen/Nosokomiale Ventrikulitis und Meningitis/Therapie - Revision history

Akelec at 08:34, 14 September 2021

2021-09-14T08:34:39Z

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	Intravenöse Applikation <ref name=":0"><span style="color: #333333">Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65</span></ref><ref name=":1"><span class="ve-pasteprotect">Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [</span><span style="color: #333333">https://www.awmf.org/leitlinien/detail/ll/030-089.html</span><span data-ve-attributes="{"style":"mso-ansi-language:DE"}" style="box-sizing: inherit"><span class="ve-pasteprotect"></span></span></ref>		Intravenöse Applikation <ref name=":b0"><span style="color: #333333">Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65</span></ref><ref name=":1"><span class="ve-pasteprotect">Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [</span><span style="color: #333333">https://www.awmf.org/leitlinien/detail/ll/030-089.html</span><span data-ve-attributes="{"style":"mso-ansi-language:DE"}" style="box-sizing: inherit"><span class="ve-pasteprotect"></span></span></ref>
	!Antibiotikum		!Antibiotikum
	!Tagesdosis (Beispiel)		!Tagesdosis (Beispiel)
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	<span class="ve-pasteProtect" style="mso-ansi-language:		<span class="ve-pasteProtect" style="mso-ansi-language:
	DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">Intrathekale Applikation </span><ref name=":0" /><ref><span style="color: #333333">Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)</span></ref>		DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">Intrathekale Applikation </span><ref name=":b0" /><ref><span style="color: #333333">Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)</span></ref>
	!Antibiotikum		!Antibiotikum
	!Tagesdosis (1xtgl.)		!Tagesdosis (1xtgl.)

imported>Bestem at 16:22, 9 September 2021

2021-09-09T16:22:56Z

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	Intravenöse Applikation <ref name=":0"><span style="color: #333333">28. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65</span></ref><ref name=":1"><span class="ve-pasteprotect"~~>31. <span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span~~>Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [</span><span style="color: #333333">https://www.awmf.org/leitlinien/detail/ll/030-089.html</span><span data-ve-attributes="{"style":"mso-ansi-language:DE"}" style="box-sizing: inherit"><span class="ve-pasteprotect"></span></span></ref>		Intravenöse Applikation <ref name=":0"><span style="color: #333333">Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65</span></ref><ref name=":1"><span class="ve-pasteprotect">Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [</span><span style="color: #333333">https://www.awmf.org/leitlinien/detail/ll/030-089.html</span><span data-ve-attributes="{"style":"mso-ansi-language:DE"}" style="box-sizing: inherit"><span class="ve-pasteprotect"></span></span></ref>
	!Antibiotikum		!Antibiotikum
	!Tagesdosis (Beispiel)		!Tagesdosis (Beispiel)
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	<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span>		<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span>

	{\| class="wikitable "		{\| class="wikitable "
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	<span class="ve-pasteProtect" style="mso-ansi-language:		<span class="ve-pasteProtect" style="mso-ansi-language:
	DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">Intrathekale Applikation </span><ref name=":0" /><ref><span style="color: #333333">32. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)</span></ref>		DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">Intrathekale Applikation </span><ref name=":0" /><ref><span style="color: #333333">Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)</span></ref>
	!Antibiotikum		!Antibiotikum
	!Tagesdosis (1xtgl.)		!Tagesdosis (1xtgl.)

imported>Fuhrmanns at 19:43, 9 August 2021

2021-08-09T19:43:32Z

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	~~{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Kalkulierte Therapie}}~~
	~~{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Erregerspezifische_Therapie}}~~
	~~<references />~~

imported>Fuhrmanns at 19:41, 9 August 2021

2021-08-09T19:41:47Z

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	~~intravenöse~~ Applikation <ref name=":0"><span style="color: #333333">28. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65</span></ref><ref name=":1"><span class="ve-pasteprotect">31. <span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span>Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [</span><span style="color: #333333">https://www.awmf.org/leitlinien/detail/ll/030-089.html</span><span data-ve-attributes="{"style":"mso-ansi-language:DE"}" style="box-sizing: inherit"><span class="ve-pasteprotect"></span></span></ref>		Intravenöse Applikation <ref name=":0"><span style="color: #333333">28. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65</span></ref><ref name=":1"><span class="ve-pasteprotect">31. <span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span>Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [</span><span style="color: #333333">https://www.awmf.org/leitlinien/detail/ll/030-089.html</span><span data-ve-attributes="{"style":"mso-ansi-language:DE"}" style="box-sizing: inherit"><span class="ve-pasteprotect"></span></span></ref>
	!Antibiotikum		!Antibiotikum
	!Tagesdosis (Beispiel)		!Tagesdosis (Beispiel)
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	<span class="ve-pasteProtect" style="mso-ansi-language:		<span class="ve-pasteProtect" style="mso-ansi-language:
	DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">~~intrathekale~~ Applikation </span><ref name=":0" /><ref><span style="color: #333333">32. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)</span></ref>		DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">Intrathekale Applikation </span><ref name=":0" /><ref><span style="color: #333333">32. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)</span></ref>
	!Antibiotikum		!Antibiotikum
	!Tagesdosis (1xtgl.)		!Tagesdosis (1xtgl.)
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	{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Kalkulierte Therapie}}		{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Kalkulierte Therapie}}
	{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Erregerspezifische_Therapie}}		{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Erregerspezifische_Therapie}}
			<references />

imported>Fuhrmanns at 19:40, 9 August 2021

2021-08-09T19:40:32Z

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	~~==Therapie==~~
	Die Fokussanierung steht im Vordergrund, infizierte Kathetersysteme sollten entfernt werden. Begleitend erfolgt eine antibiotische Therapie, die zunächst hauptsächlich auf gram-positive Kokken zielt, begleitend sind Enterobacterales und ''Pseudomonas'' ''spp''. zu erfassen. Es sollte bei Erregernachweis eine Deeskalation nach Antibiogramm erfolgen. Die Therapiedauer beträgt i.d.R. 10-14 Tage.		Die Fokussanierung steht im Vordergrund, infizierte Kathetersysteme sollten entfernt werden. Begleitend erfolgt eine antibiotische Therapie, die zunächst hauptsächlich auf gram-positive Kokken zielt, begleitend sind Enterobacterales und ''Pseudomonas'' ''spp''. zu erfassen. Es sollte bei Erregernachweis eine Deeskalation nach Antibiogramm erfolgen. Die Therapiedauer beträgt i.d.R. 10-14 Tage.

imported>Maximilian.schons@uk-koeln.de: Maximilian.schons@uk-koeln.de verschob die Seite DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie nach DGI:ZNS-Infektionen/Nosokomiale Ventrikulitis und Meningitis/Therapie: Textersetzung - „Nosokomiale Ventrikulitis und Meningitis“ du…

2021-08-03T07:39:34Z

Maximilian.schons@uk-koeln.de verschob die Seite DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie nach DGI:ZNS-Infektionen/Nosokomiale Ventrikulitis und Meningitis/Therapie: Textersetzung - „Nosokomiale Ventrikulitis und Meningitis“ du…

← Older revision	Revision as of 07:39, 3 August 2021
(No difference)

imported>Brinkery at 09:19, 31 July 2021

2021-07-31T09:19:19Z

← Older revision		Revision as of 09:19, 31 July 2021
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	{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Kalkulierte Therapie}}		{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Kalkulierte Therapie}}
	{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/~~ErregerspezifischeTherapie~~}}		{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Erregerspezifische_Therapie}}

imported>Brinkery at 09:17, 31 July 2021

2021-07-31T09:17:59Z

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	===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Kalkulierte Therapie</span><ref name=":0" /><ref name=":1" />===		{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/Kalkulierte Therapie}}
	<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{~~"style"~~:"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></~~span><~~/span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}~~"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"~~}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{~~"style":"mso-no-proof~~:~~yes"}"></span></span>Vancomycin PLUS Meropenem~~		{{DGI:Nosokomiale Ventrikulitis und Meningitis/Therapie/ErregerspezifischeTherapie}}

	Alternative zum Meropenem: Ceftazidim oder Cefepim (in Anlehnung an das lokale in-vitro-Resistenzmuster). Cephalosporine penetrieren nicht-entzündlich veränderte Meningen relativ schlecht, daher empfehlen die Autor:innen bei empirischer Anwendung dieser Substanzen: Anwendung einer höheren Loading dose und ~~ein TDM.~~
	~~(im Falle eines operativen Zugangs durch Schleimhäute PLUS Metronidazol)~~

	~~Alternative Vancomycin: Linezolid (cave: bakteriostatisch)~~
	===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Erregerspezifische Therapie</span><ref name=":0" /><ref name=":1" />===
	~~<br />~~
	~~{\| class="wikitable"~~
	~~!Erreger~~
	~~!Standardtherapie~~
	~~!Alternativtherapie~~
	\|-
	~~\|Enterobacterales (z.B. ''Klebsiella'' spp''.'', ''E. coli'')~~
	~~\|Cefotaxim/Ceftriaxon~~
	~~\|Cefepim, Meropenem, Ciprofloxacin~~
	\|-
	~~\|Enterobacterales mit induzierbaren AmpC-Betalactamasen (z.B. ''Enterobacter cloacae'') oder ESBL-Bildner~~
	~~\|Meropenem~~
	~~\|Ciprofloxacin~~
	\|-
	~~\|''Pseudomonas aeruginosa''~~
	~~\|Ceftazidim, Meropenem, Cefepim, ggf. jeweils in Kombination mit FosfomycinColistin (nur bei nachgewiesener Multiresistenz, i.v.+i.t.)~~
	~~\|Aztreonam oder Ciprofloxacin~~
	\|-
	~~\|''Acinetobacter baumanii''~~
	~~\|Meropenem~~
	~~\|Colistin (i.v.+i.t.)~~
	\|-
	~~\|''Staphylococcus'' spp. (Methicillin-empfindlich)~~
	~~\|Flucloxacillin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid~~
	~~\|Vancomycin~~
	\|-
	~~\|''Staphylococcus'' spp. (Methicillin-resistent)~~
	~~\|Vancomycin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid~~
	~~\|Linezolid~~
	\|-
	~~\|''Candida'' spp.~~
	~~\|Liposomales Amphotericin B ggf. PLUS Flucytosin~~
	~~\|Voriconazol, bei ''C. albicans'': Fluconazol~~
	\|-
	~~\|''Aspergillus'' spp.~~
	~~\|Voriconazol~~
	~~\|Liposomales Amphotericin B, Posaconazol~~
	\|}
	<br /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span>Bei Carbapenem-resistenten Gram-negativen Erregern sollte eine ergänzende intrathekale Therapie erfolgen. Für dieses Therapieregime konnte eine signifikante Reduktion der Sterblichkeit gezeigt werden <ref><span style="color: #333333">33. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Karvouniaris M, Brotis AG, Tsiamalou P, Fountas KN: The Role of Intraventricular Antibiotics in the Treatment of Nosocomial Ventriculitis/Meningitis from Gram-Negative Pathogens: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e637-e650</span></ref>. Diese Erkenntnisse konnten noch nicht in die aktuellen Leitlinien aufgenommen werden.

	~~<br~~ /~~><span class="ve-pasteProtect" style="font-size:12.0pt;line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;line-height:107%;mso-ansi-language:DE"~~}~~"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"~~}~~"></span></span><references />~~

imported>Fuhrmanns: /* Erregerspezifische Therapie[1][2] */

2021-07-26T09:53:54Z

Erregerspezifische Therapie[1][2]

← Older revision		Revision as of 09:53, 26 July 2021
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	!Alternativtherapie		!Alternativtherapie
	\|-		\|-
	\|Enterobacterales (z.B. Klebsiella spp., E. coli)		\|Enterobacterales (z.B. ''Klebsiella'' spp''.'', ''E. coli'')
	\|Cefotaxim/Ceftriaxon		\|Cefotaxim/Ceftriaxon
	\|Cefepim, Meropenem, Ciprofloxacin		\|Cefepim, Meropenem, Ciprofloxacin
	\|-		\|-
	\|Enterobacterales mit induzierbaren AmpC-Betalactamasen (z.B. Enterobacter cloacae) oder ESBL-Bildner		\|Enterobacterales mit induzierbaren AmpC-Betalactamasen (z.B. ''Enterobacter cloacae'') oder ESBL-Bildner
	\|Meropenem		\|Meropenem
	\|Ciprofloxacin		\|Ciprofloxacin
	\|-		\|-
	\|Pseudomonas aeruginosa		\|''Pseudomonas aeruginosa''
	\|Ceftazidim, Meropenem, Cefepim, ggf. jeweils in Kombination mit FosfomycinColistin (nur bei nachgewiesener Multiresistenz, i.v.+i.t.)		\|Ceftazidim, Meropenem, Cefepim, ggf. jeweils in Kombination mit FosfomycinColistin (nur bei nachgewiesener Multiresistenz, i.v.+i.t.)
	\|Aztreonam oder Ciprofloxacin		\|Aztreonam oder Ciprofloxacin
	\|-		\|-
	\|Acinetobacter baumanii		\|''Acinetobacter baumanii''
	\|~~Merope~~		\|Meropenem
	\|Colistin (i.v.+i.t.)		\|Colistin (i.v.+i.t.)
	\|-		\|-
	\|Staphylococcus spp. (Methicillin-empfindlich)		\|''Staphylococcus'' spp. (Methicillin-empfindlich)
	\|Flucloxacillin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid		\|Flucloxacillin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid
	\|Vancomycin		\|Vancomycin
	\|-		\|-
	\|Staphylococcus spp. (Methicillin-resistent)		\|''Staphylococcus'' spp. (Methicillin-resistent)
	\|Vancomycin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid		\|Vancomycin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid
	\|Linezolid		\|Linezolid
	\|-		\|-
	\|Candida spp.		\|''Candida'' spp.
	\|~~liposomales~~ Amphotericin B ggf. PLUS Flucytosin		\|Liposomales Amphotericin B ggf. PLUS Flucytosin
	\|Voriconazol, bei C. albicans: Fluconazol		\|Voriconazol, bei ''C. albicans'': Fluconazol
	\|-		\|-
	\|Aspergillus spp.		\|''Aspergillus'' spp.
	\|Voriconazol		\|Voriconazol
	\|~~liposomales~~ Amphotericin B, Posaconazol		\|Liposomales Amphotericin B, Posaconazol
	\|}		\|}
	<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span>~~Legende: i.v. = intravenös, i.t. = intrathekal~~		<br /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span>Bei Carbapenem-resistenten Gram-negativen Erregern sollte eine ergänzende intrathekale Therapie erfolgen. Für dieses Therapieregime konnte eine signifikante Reduktion der Sterblichkeit gezeigt werden <ref><span style="color: #333333">33. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Karvouniaris M, Brotis AG, Tsiamalou P, Fountas KN: The Role of Intraventricular Antibiotics in the Treatment of Nosocomial Ventriculitis/Meningitis from Gram-Negative Pathogens: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e637-e650</span></ref>. Diese Erkenntnisse konnten noch nicht in die aktuellen Leitlinien aufgenommen werden.

	Bei Carbapenem-resistenten Gram-negativen Erregern sollte eine ergänzende intrathekale Therapie erfolgen. Für dieses Therapieregime konnte eine signifikante Reduktion der Sterblichkeit gezeigt werden <ref><span style="color: #333333">33. <span class="ve-pasteprotect"><span data-ve-attributes="{"style":"mso-tab-count:1"}" style="box-sizing: inherit"> <span style="box-sizing: inherit"> </span></span></span>Karvouniaris M, Brotis AG, Tsiamalou P, Fountas KN: The Role of Intraventricular Antibiotics in the Treatment of Nosocomial Ventriculitis/Meningitis from Gram-Negative Pathogens: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e637-e650</span></ref>. Diese Erkenntnisse konnten noch nicht in die aktuellen Leitlinien aufgenommen werden.

	<br /><span class="ve-pasteProtect" style="font-size:12.0pt;line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;line-height:107%;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><references />		<br /><span class="ve-pasteProtect" style="font-size:12.0pt;line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;line-height:107%;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><references />

imported>Fuhrmanns: /* Kalkulierte Therapie[1][2] */

2021-07-26T09:48:22Z

Kalkulierte Therapie[1][2]

← Older revision		Revision as of 09:48, 26 July 2021
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	<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span>Vancomycin PLUS Meropenem		<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}"></span></span>Vancomycin PLUS Meropenem

	Alternative zum Meropenem: Ceftazidim oder Cefepim (in Anlehnung an das lokale in-vitro-Resistenzmuster). Cephalosporine penetrieren nicht-entzündlich veränderte Meningen relativ schlecht, daher empfehlen die ~~Autoren~~ bei empirischer Anwendung dieser Substanzen: Anwendung einer höheren Loading dose und ein TDM.		Alternative zum Meropenem: Ceftazidim oder Cefepim (in Anlehnung an das lokale in-vitro-Resistenzmuster). Cephalosporine penetrieren nicht-entzündlich veränderte Meningen relativ schlecht, daher empfehlen die Autor:innen bei empirischer Anwendung dieser Substanzen: Anwendung einer höheren Loading dose und ein TDM.
	(im Falle eines operativen Zugangs durch Schleimhäute PLUS Metronidazol)		(im Falle eines operativen Zugangs durch Schleimhäute PLUS Metronidazol)