DGI:Abdominelle Infektionen/Therapie/Erregerspezifische Therapie: Difference between revisions

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Eine Anpassung der antiinfektiven Therapie entsprechend des nachgewiesenen Erregerspektrums sollte so früh wie möglich erfolgen. Tabelle 7 zeigt orientierend die aktuell neu verfügbaren Antiinfektiva für die Therapie von IAI durch MRE. Eine entsprechende Therapie sollte aber immer unter Berücksichtigung des aktuellen Antibiogrammes ausgewählt werden. Tabelle 8 gibt einen Überblick zur erregerspezifischen antimykotischen Therapie.  
Eine Anpassung der antiinfektiven Therapie entsprechend des nachgewiesenen Erregerspektrums sollte so früh wie möglich erfolgen.   Orientierende Übersicht zu den aktuell neu [[#Antiinfektiva für MRE Therapie bei intraabdominellen Infektionen|verfügbaren Antiinfektiva für die Therapie von IAI durch MRE]] und der [[#Erregerspezifische Antimykotikatherapie bei IAI|erregerspezifischen antimykotischen Therapie]] kann den Tabellen entnommen werden. Für erstere sollte eine entsprechende Therapie immer unter Berücksichtigung des aktuellen Antibiogrammes ausgewählt werden.


Auch im Setting der erregerspezifischen Therapie wird die Konsequenz eines Nachweises von Candida spp. und/oder Enterokokken aus dem Bauchraum oder aus Drainagesekreten kontrovers diskutiert. Der Nachweis beider Erregergruppen ist häufig das Ergebnis einer vorhergehenden intensiven Antibiotikaexposition und entsprechenden Selektion im Setting der tertiären Peritonitis. Bisherige Studien konnten zwar zeigen, dass ein entsprechender Nachweis mit einer ungünstigen Prognose assoziiert ist. Interventionelle Studien haben jedoch keine Verbesserung der Prognose basierend auf einer auf Enterokokken bzw. Candida spp. angepassten Therapie zeigen können. Daher bleibt unklar, ob der Nachweis dieser Erreger in diesem Setting tatsächlich eine klinische Relevanz hat, die über die eines Biomarkers für eine ungünstige Prognose hinausgeht. Aus diesem Grunde kann bei einem klinisch stabilen Patienten ohne aktuelle Hinweise einer floriden Infektion in Einzelfällen auch eine zuwartende Strategie verfolgt werden.  
Auch im Setting der erregerspezifischen Therapie wird die Konsequenz eines Nachweises von Candida spp. und/oder Enterokokken aus dem Bauchraum oder aus Drainagesekreten kontrovers diskutiert. Der Nachweis beider Erregergruppen ist häufig das Ergebnis einer vorhergehenden intensiven Antibiotikaexposition und entsprechenden Selektion im Setting der tertiären Peritonitis. Bisherige Studien konnten zwar zeigen, dass ein entsprechender Nachweis mit einer ungünstigen Prognose assoziiert ist, interventionelle Studien haben jedoch keine Verbesserung der Prognose basierend auf einer auf Enterokokken bzw. Candida spp. angepassten Therapie zeigen können. Daher bleibt unklar, ob der Nachweis dieser Erreger in diesem Setting tatsächlich eine klinische Relevanz hat, die über die eines Biomarkers für eine ungünstige Prognose hinausgeht. Aus diesem Grunde kann bei einem klinisch stabilen Patient:innen ohne aktuelle Hinweise einer floriden Infektion in Einzelfällen auch eine zuwartende Strategie verfolgt werden.  
 
======Antiinfektiva für MRE Therapie bei intraabdominellen Infektionen======
{| class="wikitable"
! rowspan="2" |Erreger
! rowspan="2" |Variante
! colspan="7" |Präparat
|-
!Ceftazidim/ Avibactam
!Ceftolozan/ Tazobactam
!Imipenem/ Relebactam
!Meropenem/ Varbobactam
!Colisitin
!Cefiderocol
!Ceftobiprol
|-
! rowspan="6" |''Pseudomonas aerugionsa''
!Wildtyp
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!AmpC
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!Porinverlust (oprD-loss)
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!Effluxpumpen
| class="col-red-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!Carbapenem-R (Ø Carbapenemase)
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!MBL+
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
 
! rowspan="6" |''Entero-bacteriaceae''
!Wildtyp
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
|-
!ESBL+
| class="col-green-bg" |
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!OXA-48-like+
| class="col-green-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!KPC
| class="col-green-bg" |
| class="col-red-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!Carbapenem-R (Ø Carbapenemase)
| class="col-green-bg" |
| class="col-red-bg" |
| class="col-white-bg" |
| class="col-white-bg" |
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!MBL+ (VIM,IMP,NDM)
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
 
! rowspan="2" |''Acinetobacter baumannii''
!Wildtyp
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
!Carbapenem-R
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-
 
! rowspan="2" |''Steno-trophomonas maltophilia''
!Wildtyp
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
|-
!Carbapenem-R
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
|-


{| class="wikitable MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" width="652"
|+<span class="col-black">Tabelle 7: Spektren verfügbarer Antiinfektiva</span>
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Präparat</span>
| colspan="16" style="width:340.0pt;" width="453" |<span style="font-size:10.0pt">Erreger</span>
| style="" width="1" |
|- style="height:275.8ptpx;"
| style="width:148.8pt;" width="198" valign="top" |
| style="width:21.25pt;" width="28" |''<span style="font-size:10.0pt">P.  aerugionsa</span>'' <span style="font-size:10.0pt">WT</span>
| style="width:21.25pt;" width="28" |''<span style="font-size:10.0pt">P.  aeruginosa</span>''<span style="font-size:10.0pt"><span style="mso-spacerun:yes"> </span> AmpC</span>
| style="width:21.25pt;" width="28" |''P. aeruginosa''<span style="mso-spacerun:yes"> </span> Porinverlust  (oprD-loss)
| style="width:21.25pt;" width="28" |''<span style="font-size:10.0pt">P.  aeruginosa</span>''<span style="font-size:10.0pt"><span style="mso-spacerun:yes"> </span> Effluxpumpen</span>
| style="width:21.25pt;" width="28" |''P. aeruginosa'' <span style="mso-spacerun:yes"> </span>Carbapenem-R  (Ø Carbapenemase)
| style="width:21.4pt;" width="29" |''P. aeruginosa''<span style="mso-spacerun:yes"> </span> MBL+
| style="width:21.25pt;" width="28" |<span style="font-size:10.0pt">Enterobacteriaceae WT</span>
| style="width:21.25pt;" width="28" |<span style="font-size:10.0pt">Enterobacteriaceae ESBL+</span>
| style="width:21.25pt;" width="28" |<span style="font-size:10.0pt">Enterobacteriaceae OXA-48-like+</span>
| style="width:21.25pt;" width="28" |<span style="font-size:10.0pt">Enterobacteriaceae</span><span style="font-size:
  10.0pt;mso-ansi-language:EN-US"> </span><span style="font-size:10.0pt">KPC</span>
| style="width:21.25pt;" width="28" |Enterobacteriaceae  Carbapenem-R (Ø Carbapenemase)
| style="width:21.45pt;" width="29" |Enterobacteriaceae<span style="mso-spacerun:yes"> </span> MBL+  (VIM,IMP,NDM)
| style="width:21.25pt;" width="28" |<span style="mso-spacerun:yes"> </span>''Acinetobacter  baumannii'' WT
| style="width:21.25pt;" width="28" |<span style="mso-spacerun:yes"> </span>''Acinetobacter  baumannii'' Carbapenem-R
| style="width:21.25pt;" width="28" |''<span style="mso-spacerun:yes"> </span> Stenotrophomonas maltophilia'' WT
| colspan="2" style="width:21.4pt;" width="29" |''<span style="mso-spacerun:yes"> </span> Stenotrophomonas maltophilia'' Carbapenem-R
|- style="height:17.0ptpx;"
| style="width:148.8pt;" width="198" |Ceftazidim/ Avibactam
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| style="width:21.4pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.45pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| colspan="2" style="width:21.4pt;" class="col-red-bg" width="29" |
|- style="height:17.0ptpx;"
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Ceftolozan/  Tazobactam</span>
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.4pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.45pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| colspan="2" style="width:21.4pt;" class="col-red-bg" width="29" |
|- style="height:17.0ptpx;"
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Imipenem/  Relebactam</span>
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.4pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| style="width:21.45pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| colspan="2" style="width:21.4pt;" class="col-red-bg" width="29" |
|- style="height:17.0ptpx;"
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Meropenem/ Varbobactam</span>
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.4pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| style="width:21.45pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| colspan="2" style="width:21.4pt;" class="col-red-bg" width="29" |
|- style="height:17.0ptpx;"
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Colisitin</span>
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.4pt;" class="col-green-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| style="width:21.45pt;" class="col-white-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| colspan="2" style="width:21.4pt;" class="col-white-bg" width="29" |
|- style="height:17.0ptpx;"
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Cefiderocol</span>
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.4pt;" class="col-green-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.45pt;" class="col-green-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| colspan="2" style="width:21.4pt;" class="col-green-bg" width="29" |
|- style="height:17.0ptpx;"
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Ceftobiprol</span>
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.4pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.45pt;" class="col-red-bg" width="29" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| colspan="2" style="width:21.4pt;" class="col-red-bg" width="29" |
|}
|}
======Erregerspezifische Antimykotikatherapie bei IAI======
<br />
<br />
{| class="wikitable sortable mw-collapsible MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" width="369"
{| class="wikitable"
|+<span class="ve-pasteProtect" style="font-size:11.0pt;line-height:115%;font-family:&quot;Arial&quot;,sans-serif;
!Präparat
mso-fareast-font-family:Arial;mso-ansi-language:DE;mso-fareast-language:EN-US;
! colspan="6" |Erreger
mso-bidi-language:AR-SA" data-ve-attributes="{&quot;style&quot;:&quot;font-size:11.0pt;line-height:115%;font-family:\&quot;Arial\&quot;,sans-serif;\nmso-fareast-font-family:Arial;mso-ansi-language:DE;mso-fareast-language:EN-US;\nmso-bidi-language:AR-SA&quot;}"> </span><span class="col-black">Tabelle 8: Erregerspezifische Antimykotikatherapie bei IAI</span>
|-
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt;mso-ascii-font-family:Arial;mso-ascii-theme-font:
!
  major-latin;mso-hansi-font-family:Arial;mso-hansi-theme-font:major-latin;
!''Candida albicans''
  mso-bidi-font-family:Arial;mso-bidi-theme-font:major-latin">Präparat</span>
!''Candida glabrata''
| colspan="6" style="width:127.6pt;" width="170" |Erreger
!''Candida parapsilosis''
|- style="height:117.15ptpx;"
!''Candida krusei''
| style="width:148.8pt;" width="198" valign="top" |
!''Aspergillus fumigatus''
| style="width:21.25pt;" width="28" valign="top" |''<span style="font-size:10.0pt">Candida albicans</span>''
!''Aspergillus niger''
| style="width:21.25pt;" width="28" valign="top" |''Candida glabrata''
|-
| style="width:21.25pt;" width="28" valign="top" |''Candida parapsilosis''
!Fluconazol
| style="width:21.25pt;" width="28" valign="top" |''Candida krusei''
| class="col-green-bg" |
| style="width:21.25pt;" width="28" valign="top" |''Aspergillus fumigatus''
| class="col-orange-bg" |
| style="width:21.35pt;" width="28" valign="top" |''Aspergillus niger''
| class="col-green-bg" |
|- style="height:31.2ptpx;"
| class="col-orange-bg" |
| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Fluconazol</span>
| class="col-red-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-red-bg" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
|-
| style="width:21.25pt;" class="col-green-bg" width="28" |
!Voriconazol
| style="width:21.25pt;" class="col-white-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| class="col-white-bg" |
| style="width:21.35pt;" class="col-red-bg" width="28" |
| class="col-green-bg" |
|- style="height:31.2ptpx;"
| class="col-green-bg" |
| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Voriconazol</span>
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-blue-light-bg" width="28" |
|-
| style="width:21.25pt;" class="col-green-bg" width="28" |
!Isavuconazol
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-white-bg" |
| style="width:21.35pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
|- style="height:31.2ptpx;"
| class="col-green-bg" |
| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Isavuconazol</span>
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" valign="top" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-blue-light-bg" width="28" valign="top" |
|-
| style="width:21.25pt;" class="col-green-bg" width="28" valign="top" |
!Caspofungin
| style="width:21.25pt;" class="col-green-bg" width="28" valign="top" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" valign="top" |
| class="col-green-bg" |
| style="width:21.35pt;" class="col-green-bg" width="28" valign="top" |
| class="col-white-bg" |
|- style="height:31.2ptpx;"
| class="col-green-bg" |
| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Caspofungin</span>
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
|-
| style="width:21.25pt;" class="col-blue-light-bg" width="28" |
!Anidulafungin
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.35pt;" class="col-green-bg" width="28" |
| class="col-white-bg" |
|- style="height:31.2ptpx;"
| class="col-green-bg" |
| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Anidulafungin</span>
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
|-
| style="width:21.25pt;" class="col-blue-light-bg" width="28" |
!Micafungin
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.35pt;" class="col-green-bg" width="28" |
| class="col-white-bg" |
|- style="height:17.0ptpx;"
| class="col-green-bg" |
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Micafungin</span>
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
|-
| style="width:21.25pt;" class="col-blue-light-bg" width="28" |
!Liposomales Amphotericin B
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.35pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
|- style="height:17.0ptpx;"
| class="col-white-bg" |
| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Liposomales Amphotericin B</span>
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.25pt;" class="col-blue-light-bg" width="28" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| style="width:21.35pt;" class="col-green-bg" width="28" |
|}
|}

Latest revision as of 09:10, 21 September 2021

Eine Anpassung der antiinfektiven Therapie entsprechend des nachgewiesenen Erregerspektrums sollte so früh wie möglich erfolgen. Orientierende Übersicht zu den aktuell neu verfügbaren Antiinfektiva für die Therapie von IAI durch MRE und der erregerspezifischen antimykotischen Therapie kann den Tabellen entnommen werden. Für erstere sollte eine entsprechende Therapie immer unter Berücksichtigung des aktuellen Antibiogrammes ausgewählt werden.

Auch im Setting der erregerspezifischen Therapie wird die Konsequenz eines Nachweises von Candida spp. und/oder Enterokokken aus dem Bauchraum oder aus Drainagesekreten kontrovers diskutiert. Der Nachweis beider Erregergruppen ist häufig das Ergebnis einer vorhergehenden intensiven Antibiotikaexposition und entsprechenden Selektion im Setting der tertiären Peritonitis. Bisherige Studien konnten zwar zeigen, dass ein entsprechender Nachweis mit einer ungünstigen Prognose assoziiert ist, interventionelle Studien haben jedoch keine Verbesserung der Prognose basierend auf einer auf Enterokokken bzw. Candida spp. angepassten Therapie zeigen können. Daher bleibt unklar, ob der Nachweis dieser Erreger in diesem Setting tatsächlich eine klinische Relevanz hat, die über die eines Biomarkers für eine ungünstige Prognose hinausgeht. Aus diesem Grunde kann bei einem klinisch stabilen Patient:innen ohne aktuelle Hinweise einer floriden Infektion in Einzelfällen auch eine zuwartende Strategie verfolgt werden.

Antiinfektiva für MRE Therapie bei intraabdominellen Infektionen
Erreger Variante Präparat
Ceftazidim/ Avibactam Ceftolozan/ Tazobactam Imipenem/ Relebactam Meropenem/ Varbobactam Colisitin Cefiderocol Ceftobiprol
Pseudomonas aerugionsa Wildtyp
AmpC
Porinverlust (oprD-loss)
Effluxpumpen
Carbapenem-R (Ø Carbapenemase)
MBL+
Entero-bacteriaceae Wildtyp
ESBL+
OXA-48-like+
KPC
Carbapenem-R (Ø Carbapenemase)
MBL+ (VIM,IMP,NDM)
Acinetobacter baumannii Wildtyp
Carbapenem-R
Steno-trophomonas maltophilia Wildtyp
Carbapenem-R
Erregerspezifische Antimykotikatherapie bei IAI


Präparat Erreger
Candida albicans Candida glabrata Candida parapsilosis Candida krusei Aspergillus fumigatus Aspergillus niger
Fluconazol
Voriconazol
Isavuconazol
Caspofungin
Anidulafungin
Micafungin
Liposomales Amphotericin B
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