DGI:ZNS-Infektionen/Nosokomiale Ventrikulitis und Meningitis/Therapie: Difference between revisions
imported>Bestem No edit summary |
imported>Brinkery No edit summary |
||
| Line 5: | Line 5: | ||
=====<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Dosierungsempfehlungen antibiotischer Therapien</span>===== | =====<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Dosierungsempfehlungen antibiotischer Therapien</span>===== | ||
<span class="ve-pasteProtect" style="mso-ansi-language: | |||
DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">intravenöse Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[28, 31]</span></span> | DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">intravenöse Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[28</span></span><ref name=":0"><span style="color: rgb(51, 51, 51)">Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65</span></ref><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">, 31</span></span><ref name=":1"><span class="ve-pasteProtect" style="color: rgb(51, 51, 51)" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [</span>https://www.awmf.org/leitlinien/detail/ll/030-089.html<span class="ve-pasteProtect" style="color: rgb(51, 51, 51)" data-ve-attributes="{"style":"mso-ansi-language:DE"}">]</span></ref><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">]</span></span> | ||
{| class="wikitable sortable bs-exportable MsoTable15List1Light" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt" data-ve-attributes="{"style":"border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt"}" | {| class="wikitable sortable bs-exportable MsoTable15List1Light" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt" data-ve-attributes="{"style":"border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt"}" | ||
|+ | |+ | ||
! | ! 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:122.35pt;" class="col-grey-light-bg" width="163" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:122.35pt;"}" |'''Antibiotikum''' | ||
! | ! 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:116.45pt;" class="col-grey-light-bg" width="155" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:116.45pt;"}" |'''Tagesdosis (Beispiel)''' | ||
! | ! 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:87.25pt;" class="col-grey-light-bg" width="116" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:87.25pt;"}" |'''Bemerkung''' | ||
! | ! 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:127.55pt;" class="col-grey-light-bg" width="170" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:127.55pt;"}" |'''Anpassung''' | ||
|- style="mso-yfti-irow:0" data-ve-attributes="{"style":"mso-yfti-irow:0"}" | |- style="mso-yfti-irow:0" data-ve-attributes="{"style":"mso-yfti-irow:0"}" | ||
| 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:122.35pt;" width="163" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:122.35pt;"}" |Aztreonam | | 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:122.35pt;" width="163" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:122.35pt;"}" |Aztreonam | ||
| Line 102: | Line 102: | ||
<span class="ve-pasteProtect" style="mso-ansi-language: | |||
DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">intrathekale Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[28, 32]</span></span> | DE" data-ve-attributes="{"style":"mso-ansi-language:\nDE"}">intrathekale Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[28</span></span><ref name=":0" /><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">, 32</span></span><ref><span style="color: rgb(51, 51, 51)">Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)</span></ref><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">]</span></span> | ||
{| class="wikitable sortable bs-exportable MsoTable15List1Light" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt" data-ve-attributes="{"style":"border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt"}" | {| class="wikitable sortable bs-exportable MsoTable15List1Light" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt" data-ve-attributes="{"style":"border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt"}" | ||
|+ | |+ | ||
! | ! 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:151.2pt;" class="col-grey-light-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |'''Antibiotikum''' | ||
! | ! 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:151.2pt;" class="col-grey-light-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |'''Tagesdosis (1x tgl.)''' | ||
! | ! 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:151.2pt;" class="col-grey-light-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |'''Bemerkung''' | ||
|- style="mso-yfti-irow:0" data-ve-attributes="{"style":"mso-yfti-irow:0"}" | |- style="mso-yfti-irow:0" data-ve-attributes="{"style":"mso-yfti-irow:0"}" | ||
| 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:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Gentamicin | | 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:151.2pt;" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Gentamicin | ||
| Line 143: | Line 143: | ||
|}<br /> | |}<br /> | ||
===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Kalkulierte Therapie</span> <span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[28, 31 | ===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Kalkulierte Therapie</span> === | ||
<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[28</span></span><ref name=":0" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">, 31</span></span><ref name=":1" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">]</span></span> | |||
<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Vancomycin PLUS Meropenem</span> | <span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Vancomycin PLUS Meropenem</span> | ||
| Line 151: | Line 153: | ||
<br /> | <br /> | ||
===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Erregerspezifische Therapie</span> <span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[28, 31 | ===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;\nmso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}">Erregerspezifische Therapie</span> === | ||
<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[28</span></span><ref name=":0" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">, 31</span></span><ref name=":1" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:13.5pt;mso-fareast-font-family:\"Times New Roman\";mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">]</span></span> | |||
{| class="wikitable sortable bs-exportable MsoTable15List1Light" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt" data-ve-attributes="{"style":"border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt"}" | {| class="wikitable sortable bs-exportable MsoTable15List1Light" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt" data-ve-attributes="{"style":"border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt"}" | ||
|+ | |+ | ||
! | ! 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:151.2pt;" class="col-grey-light-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |'''Erreger''' | ||
! | ! 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:151.2pt;" class="col-grey-light-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |'''Standardtherapie''' | ||
! | ! 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:151.2pt;" class="col-grey-light-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |'''Alternativtherapie''' | ||
|- style="mso-yfti-irow:0" data-ve-attributes="{"style":"mso-yfti-irow:0"}" | |- style="mso-yfti-irow:0" data-ve-attributes="{"style":"mso-yfti-irow:0"}" | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Enterobacterales (z.B. | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Enterobacterales (z.B. Klebsiella spp., E. coli<span class="ve-pasteProtect" style="mso-bidi-font-style:italic" data-ve-attributes="{"style":"mso-bidi-font-style:italic"}">)</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Cefotaxim/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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Cefotaxim/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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Cefepim, Meropenem, Ciprofloxacin | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Cefepim, Meropenem, Ciprofloxacin | ||
|- style="mso-yfti-irow:1" data-ve-attributes="{"style":"mso-yfti-irow:1"}" | |- 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Enterobacterales mit induzierbaren AmpC-Betalactamasen (z.B. | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Enterobacterales mit induzierbaren AmpC-Betalactamasen (z.B. Enterobacter cloacae) oder ESBL-Bildner</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Meropenem</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Meropenem</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Ciprofloxacin | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Ciprofloxacin | ||
|- style="mso-yfti-irow:2" data-ve-attributes="{"style":"mso-yfti-irow:2"}" | |- 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" | | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Pseudomonas aeruginosa | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Ceftazidim, Meropenem, Cefepim, ggf. jeweils in Kombination mit Fosfomycin</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Colistin (nur bei nachgewiesener Multiresistenz, i.v.+i.t.)</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Ceftazidim, Meropenem, Cefepim, ggf. jeweils in Kombination mit Fosfomycin</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Colistin (nur bei nachgewiesener Multiresistenz, i.v.+i.t.)</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Aztreonam oder</span> Ciprofloxacin | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Aztreonam oder</span> Ciprofloxacin | ||
|- style="mso-yfti-irow:3" data-ve-attributes="{"style":"mso-yfti-irow:3"}" | |- 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" | | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Acinetobacter baumanii | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Meropenem</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Meropenem</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Colistin (i.v.+i.t.)</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{"style":"mso-ansi-language:DE"}">Colistin (i.v.+i.t.)</span> | ||
|- style="mso-yfti-irow:4" data-ve-attributes="{"style":"mso-yfti-irow:4"}" | |- 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" | | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Staphylococcus spp. (Methicillin-empfindlich) | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Flucloxacillin</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">ggf. PLUS Fosfomycin, Rifampicin oder Linezolid</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">Flucloxacillin</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{"style":"color: black"}">ggf. PLUS Fosfomycin, Rifampicin oder Linezolid</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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Vancomycin | ||
|- style="mso-yfti-irow:5" data-ve-attributes="{"style":"mso-yfti-irow:5"}" | |- 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" | | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Staphylococcus spp. (Methicillin-resistent) | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Vancomycin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Vancomycin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Linezolid | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Linezolid | ||
|- style="mso-yfti-irow:6" data-ve-attributes="{"style":"mso-yfti-irow:6"}" | |- 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" | | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Candida spp. | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |liposomales Amphotericin B ggf. PLUS Flucytosin | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |liposomales Amphotericin B ggf. PLUS Flucytosin | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Voriconazol, bei ''C. | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Voriconazol, bei ''C.'' albicans: Fluconazol | ||
|- style="mso-yfti-irow:7;mso-yfti-lastrow:yes" data-ve-attributes="{"style":"mso-yfti-irow:7;mso-yfti-lastrow:yes"}" | |- style="mso-yfti-irow:7;mso-yfti-lastrow:yes" data-ve-attributes="{"style":"mso-yfti-irow:7;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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" | | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Aspergillus spp. | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Voriconazol | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |Voriconazol | ||
| 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |liposomales Amphotericin B, Posaconazol | | 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:151.2pt;" class="col-white-bg" width="202" valign="top" data-ve-attributes="{"style":"border-left-width:3px;border-right-width:3px;border-top-width:3px;border-bottom-width:3px;border-left-color:#000000;border-right-color:#000000;border-top-color:#000000;border-bottom-color:#000000;width:151.2pt;"}" |liposomales Amphotericin B, Posaconazol | ||
| Line 193: | Line 196: | ||
<span class="ve-pasteProtect" style="font-size:12.0pt; | <span class="ve-pasteProtect" style="font-size:12.0pt; | ||
line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;\nline-height:107%;mso-ansi-language:DE"}">Bei carbapenemresistenten gram-negativen Erregern sollte eine ergänzende intrathekale Therapie erfolgen. Für dieses Therapieregime konnte eine signifikante Reduktion der Sterblichkeit gezeigt werden <span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{"style":"mso-spacerun:yes"}"> </span></span><span class="ve-pasteProtect" style="font-size:12.0pt;line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;line-height:107%;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[</span></span><span class="ve-pasteProtect" style="font-size:12.0pt; | line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;\nline-height:107%;mso-ansi-language:DE"}">Bei carbapenemresistenten gram-negativen Erregern sollte eine ergänzende intrathekale Therapie erfolgen. Für dieses Therapieregime konnte eine signifikante Reduktion der Sterblichkeit gezeigt werden <span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{"style":"mso-spacerun:yes"}"> </span></span><span class="ve-pasteProtect" style="font-size:12.0pt;line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;line-height:107%;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">[</span></span><span class="ve-pasteProtect" style="font-size:12.0pt; | ||
line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;\nline-height:107%;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{"style":"mso-spacerun:yes"}">33</span></span><span class="ve-pasteProtect" style="font-size:12.0pt;line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;line-height:107%;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">]</span>. Diese Erkenntnisse konnten noch nicht in die aktuellen Leitlinien aufgenommen werden.</span> | line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;\nline-height:107%;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{"style":"mso-spacerun:yes"}">33</span></span><ref><span style="color: rgb(51, 51, 51)">Karvouniaris M, Brotis AG, Tsiamalou P, Fountas KN: The Role of Intraventricular Antibiotics in the Treatment of Nosocomial Ventriculitis/Meningitis from Gram-Negative Pathogens: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e637-e650</span></ref><span class="ve-pasteProtect" style="font-size:12.0pt;line-height:107%;mso-ansi-language:DE" data-ve-attributes="{"style":"font-size:12.0pt;line-height:107%;mso-ansi-language:DE"}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{"style":"mso-no-proof:yes"}">]</span>. Diese Erkenntnisse konnten noch nicht in die aktuellen Leitlinien aufgenommen werden.</span> | ||
<br /> | <br /> | ||
Revision as of 19:29, 22 December 2020
Therapie
Die Fokussanierung steht im Vordergrund, infizierte Kathetersysteme sollten entfernt werden. Begleitend erfolgt eine antibiotische Therapie, die zunächst hauptsächlich auf gram-positive Kokken zielt, begleitend sind Enterobacterales und Pseudomonas spp. zu erfassen. Es sollte bei Erregernachweis eine Deeskalation nach Antibiogramm erfolgen. Die Therapiedauer beträgt i.d.R. 10-14 Tage.
Dosierungsempfehlungen antibiotischer Therapien
intravenöse Applikation [28[1], 31[2]]
| Antibiotikum | Tagesdosis (Beispiel) | Bemerkung | Anpassung |
|---|---|---|---|
| Aztreonam | 6-8g (3-4x 2g) | ||
| Cefepim | 6g (3x 2g) | CI, PI | |
| Cefotaxim | 12g (6x 2g) | ||
| Ceftazidim | 6g (3x 2g) | CI, PI, TDM | |
| Ceftriaxon | 4g (2x 2g) | ||
| Ciprofloxacin | 1200mg (3x 400mg) | ||
| Flucloxacillin | 12g (6x 2g) | TDM | |
| Fluconazol | 800mg (1x tgl.) | ||
| Fosfomycin | 24g (3x 8g) | ||
| Linezolid | 1200mg (2x 600mg) | CI, TDM | |
| liposomales Amphotericin B | 2-5 mg/kg (1x tgl.) | ||
| Meropenem | 6g (3x 2g) | CI, PI, TDM | |
| Posaconazol | 800mg (2x 400mg) | TDM | |
| Rifampicin | 600-1200mg (1-2x tgl.) | ||
| Vancomycin | 30-60 mg/kg (2-4x tgl.) | CI, TDM | |
| Voriconazol | 8 mg/kg (2x tgl.) | TDM |
Legende:
CI: kontinuierliche Infusion (engl. continuous infusion)
PI: prolongierte Infusion (engl. prolonged infusion)
TDM: Therapeutisches Drug Monitoring (engl. therapeutic drug monitoring)
intrathekale Applikation [28[1], 32[3]]
| Antibiotikum | Tagesdosis (1x tgl.) | Bemerkung |
|---|---|---|
| Gentamicin | 4-10mg | |
| Tobramycin | 5-10mg | |
| Amikacin | 30mg | |
| Colistin | 10mg | |
| Daptomycin | 5-10mg | |
| Vancomycin | 10-20mg | |
| Tigecyclin | 1-10mg | |
| Caspofungin | 5-10mg |
Kalkulierte Therapie
Vancomycin PLUS Meropenem
Alternative Meropenem: Ceftazidim oder Cefepim (im Falle eines operativen Zugangs durch Schleimhäute PLUS Metronidazol)
Alternative Vancomycin: Linezolid (cave: bakteriostatisch)
Erregerspezifische Therapie
| Erreger | Standardtherapie | Alternativtherapie |
|---|---|---|
| Enterobacterales (z.B. Klebsiella spp., E. coli) | Cefotaxim/Ceftriaxon | Cefepim, Meropenem, Ciprofloxacin |
| Enterobacterales mit induzierbaren AmpC-Betalactamasen (z.B. Enterobacter cloacae) oder ESBL-Bildner | Meropenem | Ciprofloxacin |
| Pseudomonas aeruginosa | Ceftazidim, Meropenem, Cefepim, ggf. jeweils in Kombination mit FosfomycinColistin (nur bei nachgewiesener Multiresistenz, i.v.+i.t.) | Aztreonam oder Ciprofloxacin |
| Acinetobacter baumanii | Meropenem | Colistin (i.v.+i.t.) |
| Staphylococcus spp. (Methicillin-empfindlich) | Flucloxacillinggf. PLUS Fosfomycin, Rifampicin oder Linezolid | Vancomycin |
| Staphylococcus spp. (Methicillin-resistent) | Vancomycin ggf. PLUS Fosfomycin, Rifampicin oder Linezolid | Linezolid |
| Candida spp. | liposomales Amphotericin B ggf. PLUS Flucytosin | Voriconazol, bei C. albicans: Fluconazol |
| Aspergillus spp. | Voriconazol | liposomales Amphotericin B, Posaconazol |
Legende: i.v. = intravenös, i.t. = intrathekal
Bei carbapenemresistenten gram-negativen Erregern sollte eine ergänzende intrathekale Therapie erfolgen. Für dieses Therapieregime konnte eine signifikante Reduktion der Sterblichkeit gezeigt werden [33[4]]. Diese Erkenntnisse konnten noch nicht in die aktuellen Leitlinien aufgenommen werden.
- ↑ 1.0 1.1 1.2 1.3 Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64: e34–e65
- ↑ 2.0 2.1 2.2 Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [https://www.awmf.org/leitlinien/detail/ll/030-089.html]
- ↑ Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)
- ↑ Karvouniaris M, Brotis AG, Tsiamalou P, Fountas KN: The Role of Intraventricular Antibiotics in the Treatment of Nosocomial Ventriculitis/Meningitis from Gram-Negative Pathogens: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e637-e650