imported>Brinkery |
imported>Maximilian.schons@uk-koeln.de |
| (6 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| = Klinisches Bild =
| |
| Leitsymptome:
| |
|
| |
|
| Akute Diarrhoe: ≥3 ungeformte Stuhlgänge innerhalb von 24h
| |
|
| |
| Chronische Diarrhoe: länger als 4 Wochen anhaltende Diarrhoe
| |
|
| |
| Begleitsymptome: Exsikkose, Verwirrung, Fieber, Dysenterie (Blut- und Schleimbeimengungen im Stuhl), abdominelle Schmerzen
| |
| <span style="font-size:11.0pt;line-height:115%;font-family:"Arial",sans-serif;
| |
| mso-fareast-font-family:Arial;mso-ansi-language:DE;mso-fareast-language:EN-US;
| |
| mso-bidi-language:AR-SA"> </span><span style="font-size:11.0pt;line-height:115%;font-family:"Arial",sans-serif;
| |
| mso-fareast-font-family:Arial;mso-ansi-language:DE;mso-fareast-language:EN-US;
| |
| mso-bidi-language:AR-SA"> </span>
| |
|
| |
| == <span class="mw-headline">'''<span style="color: black">Akute Diarrhoen ohne Erregernachweis</span>'''</span> ==
| |
| {| class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="background:#F8F9FA;border-collapse:collapse;border:none;mso-border-alt:
| |
| solid #A2A9B1 .75pt;mso-yfti-tbllook:1184"
| |
| | style="" |'''<span style="color: black">Klinische Situation</span>'''
| |
| | style="" |'''<span style="color: black">Diagnostik</span>'''
| |
| | style="" |'''<span style="color: black">Therapie 1. Wahl</span>'''
| |
| | style="" |'''<span style="color: black">Therapie 2. Wahl</span>'''
| |
| | style="" |'''<span style="color: black">Komplikationen/Hygiene Hinweise/Meldepflicht</span>'''
| |
| |- style="mso-yfti-irow:1"
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Ambulant erworben (≤72h stationär)</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Keine Immunsuppression</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Keine Zeichen der schweren Dehydratation/</span><span style="color: black">[https://abbuch.uk-koeln.de/index.php/Sepsis <span style="color: black">Sepsis</span>]</span>
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Spezifische Diagnostik nicht regelhaft notwendig*</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Typische Erreger: Diversive Viren, Enteropathogene ''E. coli'', ''C. difficile'', Salmonellen, Shigellen, Campylobacter und Yersinien</span>
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Ambulante, supportive Therapie mit oraler Flüssigkeits- und Elekrolytzufuhr</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Keine empirische antimikrobielle Therapie</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Häufig selbstlimitierend</span>
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">-</span>
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">*In folgenden Untergruppen ist eine Diagnostik notwendig:</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Blutige Diarrhö</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Patienten, die in Gemeinschaftseinrichtungen oder Lebensmittel verarbeitenden Institutionen arbeiten</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Bei Personen mit stattgehabter</span> <span style="color: black">[https://abbuch.uk-koeln.de/index.php/Antibiotika <span style="color: black">Antibiotika</span>]</span><span style="color: black">-Einnahme innerhalb der letzten 3 Monate</span>
| |
| |- style="mso-yfti-irow:2"
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Nosokomial erworben (>72h stationär) oder ambulant erworben plus</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Immunsuppression und/oder</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Zeichen der schweren Dehydratati</span><span style="color: black">on/[https://abbuch.uk-koeln.de/index.php/Sepsis <span style="color: black">Sepsis</span>]</span>
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Basisdiagnostik Stuhl: Norovirus, Rotavirus, Adenovirus, Enteropathogene ''E. coli'', ''C. difficile'', Salmonellen, Shigellen, Campylobacter, Yersinien</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Abnahme von 2 Pärchen Blutkulturen</span>
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Flüssigkeits- und Elekrolytausgleich</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">keine primär empirische antimikrobielle Therapie</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">häufig selbstlimitierend</span>
| |
| | style="" |<span style="color: black">Bei schweren Verläufen oder Verläufe >3 Tage (NACH Abnahme der Stuhldiagnostik):</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span style="color: black">Ciprofloxacin</span>]</span> <span style="color: black">2x 500 mg oral für 3-5 Tage oder</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Azithromycin <span style="color: black">Azithromycin</span>]</span> <span style="color: black">1x 500 mg oral für 3 Tage</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">(alternativ [https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span style="color: black">Ciprofloxacin</span>] 2x 400 mg i.v. für 3-5 Tage oder [https://abbuch.uk-koeln.de/index.php/Antibiotika#Ceftriaxon <span style="color: black">Ceftriaxon</span>] 1x 2g i.v. für 3-5 Tage)</span>
| |
| | rowspan="2" style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Isolation bei Krankenhausaufnahme bis 48h durchfallfrei</span>
| |
| |- style="mso-yfti-irow:3;mso-yfti-lastrow:yes"
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Nach Fernreise</span>
| |
| | style="" |<span style="color: black">Bei Durchfällen > 5 Tage, blutiger Diarrhoe, bei schweren Verläufen oder Gruppenerkrankungen:</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Basisdiagnostik Stuhl (s.o.)</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Enteropathogene ''E. coli'' (PCR)</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Protozoen (Amöben, Lamblien) aus drei unabhängigen Stuhlproben</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Zusätzlich bei Fieber: Blutkulturen (mindesten zwei) UND</span> <span style="color: black">[https://abbuch.uk-koeln.de/index.php/Malaria_und_andere_parasit%C3%A4re_Infektionen#Malaria <span style="color: #0B0080">Malaria</span>]</span><span style="color: black">-Diagnostik (wenn zum Reiseland passend)</span>
| |
| | style="" |<span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Flüssigkeits- und Eleketrolytausgleich,</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">keine primär empirische antimikrobielle Therapie</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">keine motilitätshemmende Therapie</span>
| |
| | style="" |<span style="color: black">Bei blutiger Diarrhoe, Fieber oder Risikopatienten (Immunsuppression):</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">[https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span style="color: black">Ciprofloxacin</span>]</span> <span style="color: black">2 x 500 mg oral für 3-5 Tage (alternativ [https://abbuch.uk-koeln.de/index.php/Antibiotika#Ciprofloxacin <span style="color: black">Ciprofloxacin</span>] 2x 400 mg i.v. für 3-5 Tage)</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">oder [https://abbuch.uk-koeln.de/index.php/Antibiotika#Azithromycin <span style="color: black">Azithromycin</span>] 1x 500 mg p.o. für 3 Tage (alternativ [https://abbuch.uk-koeln.de/index.php/Antibiotika#Azithromycin <span style="color: black">Azithromycin</span>] 1000 mg einmalig)</span>
| |
|
| |
| <span style="color: black"><span style="mso-list:Ignore">· <span style="font:7.0pt "Times New Roman""> </span></span></span><span style="color: black">Bei dringendem V.a. eine Infektion mit Amöben: [https://abbuch.uk-koeln.de/index.php/Antibiotika#Metronidazol <span style="color: black">Metronidazol</span>] 3x 10 mg/kg KG/Tag (max 3x 800 mg) oral oder i.v. für 10 Tage</span>
| |
| |}
| |
