imported>Brinkery |
imported>Brinkery |
| Line 1: |
Line 1: |
| ==Therapie== | | ==Therapie== |
| | '''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Prinzipien der Therapie</span>''' |
|
| |
|
| ===='''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Prinzipien der Therapie</span>'''====
| | <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Schnell: So früh wie möglich. <span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{"style":"mso-spacerun:yes"}"> </span></span> |
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Merke:</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}"> Schnell. So früh wie möglich. <span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{"style":"mso-spacerun:yes"}"> </span></span>
| |
|
| |
|
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Therapiebeginn nach Blutkultur, ggf. Atemwegssekret zur mikrobiol. Untersuchung - dadurch jedoch keine Therapieverzögerung</span>
| | Therapiebeginn nach Blutkultur, ggf. Atemwegssekret zur mikrobiologischen Untersuchung - dadurch jedoch keine Therapieverzögerung |
|
| |
|
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Sepsis: </span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Beginn der Antibiotikatherapie innerhalb einer Stunde (</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">“''golden hour'' of ''sepsis''”)</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">!</span>
| | Sepsis: Beginn der Antibiotikatherapie innerhalb einer Stunde (“golden hour of sepsis”) |
|
| |
|
| ====='''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Wichtige Therapieprinzipien:</span>'''=====
| | Kalkulierte Therapie anhand zu erwartender Erreger |
|
| |
|
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Kalkulierte Therapie anhand zu erwartender Erreger</span>
| | Lokales Erregerspektrum und Resistenzprofil berücksichtigen |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Lokales Erregerspektrum und Resistenzprofil berücksichtigen</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Candida spp. in Atemwegsmaterial: In der Regel keine antimykotische Therapie</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Applikation: Falls Sepsis, dann prolongierte Gabe von Betalaktam-AB nach Startdosis erwägen (Perfusor)</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Keine antibiotische Therapie einer VAT (≠ VAP)</span>
| |
|
| |
|
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Keine inhalative Therapie der VAP. Ausnahme: Als Ergänzung der Therapie gegen gram-negative Erreger, die nur auf Colistin und/oder Aminoglykoside empfindlich sind, prüfen:</span>
| | Candida spp. in Atemwegsmaterial: In der Regel keine antimykotische Therapie |
|
| |
|
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Therapiedauer 7 bis 8 Tage, ''S. aureus''-Bakteriämie 14 TageUnklare Emfehlungen zur Procalcitonin (PCT)-Steuerung:</span>
| | Applikation: Falls Sepsis, dann prolongierte Gabe von Betalaktam-AB nach Startdosis erwägen (Perfusor) |
| **<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Nicht verwenden, allein klin. Kriterien reichen (ATS 2016)</span>
| |
| **<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Nicht, wenn erwartete AMT < 7 - 8 Tage), nur in ausgewählten Fällen (z. B. Colistin-Therapie, MRE) (ERS u. a. 2017)</span>
| |
| | |
| ===='''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Empirische Therapie</span>'''====
| |
| <br />
| |
| {| class="wikitable sortable bs-exportable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" style="border-collapse:collapse;border:none;mso-border-alt:solid black .5pt;" data-ve-attributes="{"style":"border-collapse:collapse;border:none;mso-border-alt:solid black .5pt;"}"
| |
| |+
| |
| ! colspan="6" |'''HAP ohne MRE-Risiko (s. u.)'''
| |
| '''Häufige Erreger: Enterobakterien, H. influenzae, S. aureus (MSSA), S. pneumoniae'''
| |
| |- style="mso-yfti-irow:1" data-ve-attributes="{"style":"mso-yfti-irow:1"}"
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;" class="col-grey-light-bg" width="80" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;"}" |'''Präferenz'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" class="col-grey-light-bg" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |'''Substanz'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" class="col-grey-light-bg" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |'''Dosierung'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" class="col-grey-light-bg" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |'''Dauer'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;" class="col-grey-light-bg" width="109" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;"}" |'''Anpassungen'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;" class="col-grey-light-bg" width="119" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;"}" |'''Kommentar'''
| |
| |- style="mso-yfti-irow:2" data-ve-attributes="{"style":"mso-yfti-irow:2"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;" width="80" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;"}" |Therapie der Wahl
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |Ampicillin/Sulbactam
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |3-4x 3 g i.v.
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;" width="109" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;" width="119" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;"}" |Leichter Verlauf: Amoxicillin/Clavulansäure p.o.
| |
| |- style="mso-yfti-irow:3" data-ve-attributes="{"style":"mso-yfti-irow:3"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;" width="80" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |Ceftriaxon
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |1x 2 g i.v.
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;" width="109" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;" width="119" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;"}" |
| |
| |- style="mso-yfti-irow:4" data-ve-attributes="{"style":"mso-yfti-irow:4"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;" width="80" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;"}" |2. Wahl
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |Levofloxacin
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |1-2x 500 mg i.v.
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;" width="109" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;" width="119" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;"}" |
| |
| |- style="mso-yfti-irow:5" data-ve-attributes="{"style":"mso-yfti-irow:5"}"
| |
| ! colspan="6" |'''HAP mit MRE-Risiko (s. u.)'''
| |
| '''Häufige Erreger: Zusätzlich Pseudomonas aeruginosa, Acinetobacter baumanii, Stenotrophomonas maltophilia, MRSA, ESBL-Bildner'''
| |
| |- style="mso-yfti-irow:6" data-ve-attributes="{"style":"mso-yfti-irow:6"}"
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;" class="col-grey-light-bg" width="80" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;"}" |'''Präferenz'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" class="col-grey-light-bg" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |'''Substanz'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" class="col-grey-light-bg" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |'''Dosierung'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" class="col-grey-light-bg" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |'''Dauer'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;" class="col-grey-light-bg" width="109" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;"}" |'''Anpassungen'''
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;" class="col-grey-light-bg" width="119" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;"}" |'''Kommentar'''
| |
| |- style="mso-yfti-irow:7" data-ve-attributes="{"style":"mso-yfti-irow:7"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;" width="80" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;"}" |Therapie der Wahl
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |Piperacillin/Tazobactam
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |3-4 x 4,5 g i.v.
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |7 d
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |
| |
| |- style="height:12.65ptpx;" data-ve-attributes="{"style":"height:12.65ptpx;"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |Ceftazidim <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">*)</span>oder Cefepim
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |3x 2 g i.v.
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |
| |
| |- style="mso-yfti-irow:9" data-ve-attributes="{"style":"mso-yfti-irow:9"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |2. Wahl
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |Imipenem
| |
| Meropenem
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |3-4 x 1 g i.v.
| |
| 3 x 1-2 g
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |
| |
| |- style="mso-yfti-irow:10" data-ve-attributes="{"style":"mso-yfti-irow:10"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;" width="80" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |ggf. plus Levofloxacin **)
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |2x 500 mg
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |
| |
| |- style="mso-yfti-irow:11" data-ve-attributes="{"style":"mso-yfti-irow:11"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;" width="80" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |oder ggf. plus Gentamicin nach KG
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |1 x 3-7 mg/kg
| |
| KG
| |
| | |
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Tal-spiegel <1 μg/ml</span>
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |De-Eskalation s. u.
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;"}" |Mono-/Kombi-Therapie s. u.
| |
| <nowiki>*</nowiki>)Ceftazidim nur in Kombi mit Pneumokokken-wirksamer Substanz
| |
| | |
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">**) Kombinations-therapie bei lebensbedrohlicher Infektion (Sepsis-assoziierte Organdysfunktion oder invasive Beatmung)</span>
| |
| |- style="mso-yfti-irow:12;mso-yfti-lastrow:yes" data-ve-attributes="{"style":"mso-yfti-irow:12;mso-yfti-lastrow:yes"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;" width="80" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:60.0pt;"}" |Falls V. a. MRSA
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;" width="150" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:112.3pt;"}" |plus Vancomycin
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;" width="85" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:63.55pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">2 x 15 mg/kg KG</span>
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;" width="56" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:42.1pt;"}" |
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;" width="109" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:81.45pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Bei Sepsis initial: 25-30 mg/kgKG</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">als Dauer-infusion</span>
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;" width="119" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:89.1pt;"}" |Spiegel-Messungen(!)
| |
| nach der 3. Dosis: | |
| | |
| Talspiegel <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">15–20 mg/l (bei kontinuierlicher Gabe bis 20 mg/l)</span>
| |
| | |
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">cave Nephrotoxizität</span>
| |
| |}<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Kombinationstherapie:<span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{"style":"mso-spacerun:yes"}"> </span></span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Sepsis oder invasive Beatmungspflichtigkeit</span>
| |
| | |
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Monotherapie:</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Nur wenn Sepsis-Organdysfunktion ausgeschlossen ist und keine Beatmung erfolgt</span>
| |
| | |
| '''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Deeskalation:</span>''' <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Nach 48-72 h Möglichkeit der Deeskalation auf Monotherapie (Betalaktam, FQ 2. Wahl) prüfen (klinische Besserung, kein mikrobiologischer Nachweis), gezielte Monotherapie, falls mikrobiologischer Nachweis. <span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{"style":"mso-spacerun:yes"}"> </span></span>
| |
| | |
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Initiale kalkulierte Therapie gegen MRSA beenden, falls MRSA nicht nachgewiesen wurde, bzw. bei positivem MSSA Nachweis entsprechend umstellen. </span>
| |
|
| |
|
| | Keine antibiotische Therapie einer VAT (≠ VAP)Keine inhalative Therapie der VAP. Zu prüfende Ausnahme: Als Ergänzung der Therapie gegen gram-negative Erreger, die nur auf Colistin und/oder Aminoglykoside empfindlich sind |
|
| |
|
| <span class="ve-pasteProtect" style="font-size:12.0pt;line-height:115%" data-ve-attributes="{"style":"font-size:12.0pt;line-height:115%"}">Therapierelevante Risikofaktoren für MRE bei nosokomialer Pneumonie:</span>
| | Therapiedauer 7 bis 8 Tage, S. aureus-Bakteriämie 14 Tage |
|
| |
|
| *<span class="ve-pasteProtect" style="font-size:12.0pt;line-height:115%" data-ve-attributes="{"style":"font-size:12.0pt;line-height:115%"}">Antimikrobielle Therapie in den letzten 90 Tagen</span>
| | Unklare Empfehlungen zur Procalcitonin (PCT)-Steuerung: |
| *<span class="ve-pasteProtect" style="font-size:12.0pt;line-height:115%" data-ve-attributes="{"style":"font-size:12.0pt;line-height:115%"}">Hospitalisierung ⋝ 5 Tage</span>
| |
| *<span class="ve-pasteProtect" style="font-size:12.0pt;line-height:115%" data-ve-attributes="{"style":"font-size:12.0pt;line-height:115%"}">Kolonisierung durch MRGN oder MRSA</span>
| |
| *<span class="ve-pasteProtect" style="font-size:12.0pt;line-height:115%" data-ve-attributes="{"style":"font-size:12.0pt;line-height:115%"}">Medizinische Versorgung in Süd- und Osteuropa, Afrika, Naher Osten, Asien</span>
| |
| *<span class="ve-pasteProtect" style="font-size:12.0pt;line-height:115%" data-ve-attributes="{"style":"font-size:12.0pt;line-height:115%"}">Septischer Schock, sepsisassoziierte Organdysfunktion</span>
| |
| *<span class="ve-pasteProtect" style="font-size:12.0pt;line-height:115%;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol" data-ve-attributes="{"style":"font-size:12.0pt;line-height:115%;font-family:Symbol;mso-fareast-font-family:\nSymbol;mso-bidi-font-family:Symbol"}"><span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{"style":"mso-list:Ignore"}"><span class="ve-pasteProtect" style="font:7.0pt "Times New Roman"" data-ve-attributes="{"style":"font:7.0pt \"Times New Roman\""}"> </span></span></span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Invasive Beatmung mehr als 4-6 Tage</span>
| |
|
| |
|
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Intensivstation-Aufenthalt</span> | | * Nicht verwenden, allein klin. Kriterien reichen (ATS 2016) |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Malnutrition</span>
| | * Nicht, wenn erwartete AMT < 7 - 8 Tage, nur in ausgewählten Fällen (z. B. Colistin-Therapie, MRE) (ERS u. a. 2017) |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Strukturelle Lungenerkrankung</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Bek. Kolonisation durch MRE</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Aufnahme aus Langzeitpflege</span> | |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Chronische Dialyse</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Tracheostoma</span><span class="ve-pasteProtect" style="font-size: 12.0pt;mso-bidi-font-size:11.0pt;line-height:115%" data-ve-attributes="{"style":"font-size:\n12.0pt;mso-bidi-font-size:11.0pt;line-height:115%"}">träger</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Offene Hautwunden</span>
| |
|
| |
|
| <br /> | | <br /> |
| ===='''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Therapie besonderer Keime </span>'''====
| |
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Immer Resistogramm berücksichtigen.</span>
| |
| <br />
| |
| {| class="wikitable sortable bs-exportable MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" data-ve-attributes="{"style":"width:100%;"}"
| |
| |+
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;" class="col-grey-light-bg" width="198" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Keim'''</span>
| |
| ! style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;" class="col-grey-light-bg" width="416" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">'''Therapieoptionen (nach Resistenzsituation)'''</span>
| |
| |- style="mso-yfti-irow:1" data-ve-attributes="{"style":"mso-yfti-irow:1"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;" width="198" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">MRSA</span>
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;" width="416" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Vancomycin oder Linezolid als Monotherapie</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Teicoplanin und Ceftobiprol. Ceftobiprol ist für die Be-handlung der HAP, nicht jedoch VAP zugelassen</span>
| |
| |- style="mso-yfti-irow:2" data-ve-attributes="{"style":"mso-yfti-irow:2"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;" width="198" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">P. aeruginosa</span>
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;" width="416" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;"}" |Cefepim, Piperacillin, Imipenem, Meropenem, Ciprofloxacin, Levofloxacin. <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Multiresistenz: Kombination mit Colistin erwägen</span>
| |
| |- style="mso-yfti-irow:3" data-ve-attributes="{"style":"mso-yfti-irow:3"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;" width="198" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">ESBL</span>
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;" width="416" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Bei Enterobacteriaceae, die ESBL (Extendend-Spectrum-Beta-Laktamasen) produzieren, werden Carbapeneme empfohlen; CAVE: In Ländern mit hohem Carbapenem-Verbrauch Anstieg der Resistenz. Weitere gut wirksame Substanzen mit HAP-/VAP-Zulassung: Ceftazidim-Avibactam</span>
| |
| |- style="mso-yfti-irow:4" data-ve-attributes="{"style":"mso-yfti-irow:4"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;" width="198" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">CRE</span>
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;" width="416" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Colistin, möglichst in Kombination (z. B. mit Aminoglykosid), Fosfomycin, ein Carbapenem und Ceftazidim/Avibactam</span>
| |
| |- style="mso-yfti-irow:5" data-ve-attributes="{"style":"mso-yfti-irow:5"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;" width="198" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Acinetobacter baumannii</span>
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;" width="416" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Imipenem oder Meropenem. Falls Resistenz, dann Colistin, möglichst in Kombination mit einer weiteren in vitro wirksamen Substanz.</span>
| |
| |- style="mso-yfti-irow:6;mso-yfti-lastrow:yes" data-ve-attributes="{"style":"mso-yfti-irow:6;mso-yfti-lastrow:yes"}"
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;" width="198" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:148.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Stenotrophomonas maltophilia</span>
| |
| | style="border-left-width:1px;border-right-width:1px;border-top-width:1px;border-bottom-width:1px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;" width="416" valign="top" data-ve-attributes="{"style":"border-left-width:2px;border-right-width:2px;border-top-width:2px;border-bottom-width:2px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:311.8pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Klinische Relevanz – Besiedlung vs. Infektion? Co-Trimoxazol</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Cotrimoxazol-Resistenz: Empfindlichkeitstestung auf Ceftazidim, Moxifloxacin, Levofloxacin</span>
| |
| |}
| |
|
| |
| ===='''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Umgang mit Therapieversagen</span>'''====
| |
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}"><span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{"style":"mso-list:Ignore"}">1. <span class="ve-pasteProtect" style="font:7.0pt "Times New Roman"" data-ve-attributes="{"style":"font:7.0pt \"Times New Roman\""}"> </span></span></span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Diagnose „HAP“ korrekt? Überprüfen:</span> <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Resistente bakterielle Erreger</span>
| |
|
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Nicht-bakterielle Erreger</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Resistenzentwicklung unter Therapie</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Unterdosierung der antimikrobiellen Therapie</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Superinfektion mit „neuem“ Erreger</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}"><span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{"style":"mso-list:Ignore"}"><span class="ve-pasteProtect" style="font:7.0pt "Times New Roman"" data-ve-attributes="{"style":"font:7.0pt \"Times New Roman\""}"> </span></span></span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Einschmelzende/organüberschreitende Infektion oder Komplikation (z. B. Lungenabszess, Pleuraempyem)</span>
| |
|
| |
| <span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}"><span class="ve-pasteProtect" style="mso-list:Ignore" data-ve-attributes="{"style":"mso-list:Ignore"}">2. <span class="ve-pasteProtect" style="font:7.0pt "Times New Roman"" data-ve-attributes="{"style":"font:7.0pt \"Times New Roman\""}"> </span></span></span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Liegt eine andere Diagnose vor?</span>
| |
|
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Andere Lungenerkrankung (z. B. interstitielle Lungenerkrankung, Atelektase, Karzinom)</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Lungenödem/Herzinsuffizienz</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Lungenembolie/Lungeninfarkt</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Alveoläre Hämorrhagie</span>
| |
| *<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Aspirati</span><span class="ve-pasteProtect" style="font-size: 12.0pt;mso-bidi-font-size:11.0pt;line-height:115%" data-ve-attributes="{"style":"font-size:\n12.0pt;mso-bidi-font-size:11.0pt;line-height:115%"}">on</span>
| |
