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.  


{| class="wikitable"
======Antiinfektiva für MRE Therapie bei intraabdominellen Infektionen======
|+
{| class="wikitable"
! rowspan="2" |Erreger
! rowspan="2" |Erreger
! rowspan="2" |Variante
! colspan="7" |Präparat
! colspan="7" |Präparat
|-
|-
Line 13: Line 14:
!Imipenem/ Relebactam
!Imipenem/ Relebactam
!Meropenem/ Varbobactam
!Meropenem/ Varbobactam
!Colisitin        
!Colisitin
!Cefiderocol    
!Cefiderocol
!Ceftobiprol  
!Ceftobiprol
|-
|-
!|P. aerugionsa WT
! rowspan="6" |''Pseudomonas aerugionsa''
!Wildtyp
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
Line 26: Line 28:
| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
!P. aeruginosa  AmpC
!AmpC
| class="col-white-bg" |
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
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| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
 
!Porinverlust (oprD-loss)
|-
!|P. aeruginosa  Porinverlust (oprD-loss)
| class="col-white-bg" |
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
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| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
 
!Effluxpumpen
!|P. aeruginosa  Effluxpumpen
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
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| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
 
!Carbapenem-R (Ø Carbapenemase)
!|P. aeruginosa  Carbapenem-R (Ø Carbapenemase)
| class="col-white-bg" |
| class="col-white-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
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| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
 
!MBL+
!|P. aeruginosa  MBL+
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
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|-
|-


!|Entero-bacteriaceae WT
! rowspan="6" |''Entero-bacteriaceae''
!Wildtyp
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-green-bg" |
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| class="col-green-bg" |
| class="col-green-bg" |
|-
|-
 
!ESBL+
!|Entero-bacteriaceae ESBL+
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-white-bg" |
| class="col-white-bg" |
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| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
 
!OXA-48-like+
!|Entero-bacteriaceae OXA-48-like+
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
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| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
 
!KPC
!|Entero-bacteriaceae KPC
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
Line 116: Line 111:
| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
 
!Carbapenem-R (Ø Carbapenemase)
!|Entero-bacteriaceae Carbapenem-R (Ø Carbapenemase)
| class="col-green-bg" |
| class="col-green-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
Line 126: Line 120:
| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
 
!MBL+ (VIM,IMP,NDM)
!|Entero-bacteriaceae  MBL+ (VIM,IMP,NDM)
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
Line 137: Line 130:
|-
|-


!|Acinetobacter baumannii WT
! rowspan="2" |''Acinetobacter baumannii''
!Wildtyp
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
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| class="col-red-bg" |
| class="col-red-bg" |
|-
|-
 
!Carbapenem-R
!|Acinetobacter baumannii Carbapenem-R
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
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|-
|-


!|Steno-trophomonas maltophilia WT
! rowspan="2" |''Steno-trophomonas maltophilia''
!Wildtyp
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
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| class="col-green-bg" |
| class="col-green-bg" |
|-
|-
 
!Carbapenem-R
!|Steno-trophomonas maltophilia Carbapenem-R
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
| class="col-red-bg" |
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|}
|}
{| class="wikitable MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" width="652"
======Erregerspezifische Antimykotikatherapie bei IAI======
|+Tabelle 7: Spektren verfügbarer Antiinfektiva
| style="width:148.8pt;" width="198" |<small>Präparat</small>
| colspan="16" style="width:340.0pt;" width="453" |<small>Erreger</small>
| style="" width="1" |
|- style="height:275.8ptpx;"
| style="width:148.8pt;" width="198" valign="top" |
| style="width:21.25pt;" width="28" |<small>P.  aerugionsa WT</small>
| style="width:21.25pt;" width="28" |<small>P.  aeruginosa  AmpC</small>
| style="width:21.25pt;" width="28" |<small>P. aeruginosa  Porinverlust  (oprD-loss)</small>
| style="width:21.25pt;" width="28" |<small>P.  aeruginosa  Effluxpumpen</small>
| style="width:21.25pt;" width="28" |<small><code>P. aeruginosa  Carbapenem-R  (Ø Carbapenemase)</code></small>
| style="width:21.4pt;" width="29" |<small>P. aeruginosa  MBL+</small>
| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae WT</small>
| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae ESBL+</small>
| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae OXA-48-like+</small>
| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae KPC</small>
| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae  Carbapenem-R (Ø Carbapenemase)</small>
| style="width:21.45pt;" width="29" |<small>Entero-bacteriaceae  MBL+  (VIM,IMP,NDM)</small>
| style="width:21.25pt;" width="28" |<small>Acinetobacter  baumannii WT</small>
| style="width:21.25pt;" width="28" |<small>Acinetobacter  baumannii Carbapenem-R</small>
| style="width:21.25pt;" width="28" |<small>Steno-trophomonas maltophilia WT</small>
| colspan="2" style="width:21.4pt;" width="29" |<small>Steno-trophomonas maltophilia Carbapenem-R</small>
|- style="height:17.0ptpx;"
| style="width:148.8pt;" width="198" |<small>Ceftazidim/ Avibactam</small>
| 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" |<small>Ceftolozan/  Tazobactam</small>
| 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" |<small>Imipenem/  Relebactam</small>
| 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" |<small>Meropenem/ Varbobactam</small>
| 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" |<small>Colisitin</small>
| 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" |<small>Cefiderocol</small>
| 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" |<small>Ceftobiprol</small>
| 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" |
|}
<br />
<br />
{| class="wikitable sortable mw-collapsible MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" width="369"
{| class="wikitable"
|+Tabelle 8: Erregerspezifische Antimykotikatherapie bei IAI
!Präparat
| style="width:148.8pt;" width="198" |<small>Präparat</small>
! colspan="6" |Erreger
| colspan="6" style="width:127.6pt;" width="170" |<small>Erreger</small>
|-
|- style="height:117.15ptpx;"
!
| style="width:148.8pt;" width="198" valign="top" |
!''Candida albicans''
| style="width:21.25pt;" width="28" valign="top" |<small>Candida albicans</small>
!''Candida glabrata''
| style="width:21.25pt;" width="28" valign="top" |<small>Candida glabrata</small>
!''Candida parapsilosis''
| style="width:21.25pt;" width="28" valign="top" |<small>Candida parapsilosis</small>
!''Candida krusei''
| style="width:21.25pt;" width="28" valign="top" |<small>Candida krusei</small>
!''Aspergillus fumigatus''
| style="width:21.25pt;" width="28" valign="top" |<small>Aspergillus fumigatus</small>
!''Aspergillus niger''
| style="width:21.35pt;" width="28" valign="top" |<small>Aspergillus niger</small>
|-
|- style="height:31.2ptpx;"
!Fluconazol
| style="width:148.8pt;" width="198" valign="top" |<small>Fluconazol</small>
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-orange-bg" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-orange-bg" |
| style="width:21.25pt;" class="col-white-bg" width="28" |
| class="col-red-bg" |
| style="width:21.25pt;" class="col-red-bg" width="28" |
| class="col-red-bg" |
| style="width:21.35pt;" class="col-red-bg" width="28" |
|-
|- style="height:31.2ptpx;"
!Voriconazol
| style="width:148.8pt;" width="198" valign="top" |<small>Voriconazol</small>
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-white-bg" |
| style="width:21.25pt;" class="col-blue-light-bg" width="28" |
| 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" |
| 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" |
|-
|- style="height:31.2ptpx;"
!Isavuconazol
| style="width:148.8pt;" width="198" valign="top" |<small>Isavuconazol</small>
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" valign="top" |
| class="col-white-bg" |
| style="width:21.25pt;" class="col-blue-light-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:21.25pt;" 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" |
|-
|- style="height:31.2ptpx;"
!Caspofungin
| style="width:148.8pt;" width="198" valign="top" |<small>Caspofungin</small>
| 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" |
| class="col-white-bg" |
| style="width:21.25pt;" class="col-blue-light-bg" width="28" |
| 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" |
| class="col-green-bg" |
| style="width:21.35pt;" class="col-green-bg" width="28" |
|-
|- style="height:31.2ptpx;"
!Anidulafungin
| style="width:148.8pt;" width="198" valign="top" |<small>Anidulafungin</small>
| 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" |
| class="col-white-bg" |
| style="width:21.25pt;" class="col-blue-light-bg" width="28" |
| 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" |
| class="col-green-bg" |
| style="width:21.35pt;" class="col-green-bg" width="28" |
|-
|- style="height:17.0ptpx;"
!Micafungin
| style="width:148.8pt;" width="198" |<small>Micafungin</small>
| 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" |
| class="col-white-bg" |
| style="width:21.25pt;" class="col-blue-light-bg" width="28" |
| 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" |
| class="col-green-bg" |
| style="width:21.35pt;" class="col-green-bg" width="28" |
|-
|- style="height:17.0ptpx;"
!Liposomales Amphotericin B
| style="width:148.8pt;" width="198" |<small>Liposomales Amphotericin B</small>
| 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" |
| class="col-green-bg" |
| style="width:21.25pt;" class="col-green-bg" width="28" |
| class="col-white-bg" |
| style="width:21.25pt;" class="col-blue-light-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" |
|}
|}

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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