DGI:ZNS-Infektionen/Nosokomiale Ventrikulitis und Meningitis/Therapie: Difference between revisions

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=====<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Dosierungsempfehlungen antibiotischer Therapien</span>=====
=====<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Dosierungsempfehlungen antibiotischer Therapien</span>=====
<span class="ve-pasteProtect" style="mso-ansi-language:
<span class="ve-pasteProtect" style="mso-ansi-language:
DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:\nDE&quot;}">intravenöse Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[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="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">, 31</span></span><ref name=":1"><span class="ve-pasteProtect" style="color: rgb(51, 51, 51)" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:\nDE&quot;}">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="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}">]</span></ref><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span></span>
DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:\nDE&quot;}">intravenöse Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[28</span></span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">, 31</span></span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span></span><ref name=":0"><span style="color: #333333">28. <span class="ve-pasteprotect"><span data-ve-attributes="{&quot;style&quot;:&quot;mso-tab-count:1&quot;}" style="box-sizing: inherit">          <span style="box-sizing: inherit"> </span></span></span>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><ref name=":1"><span class="ve-pasteprotect">31. <span data-ve-attributes="{&quot;style&quot;:&quot;mso-tab-count:1&quot;}" style="box-sizing: inherit">          <span style="box-sizing: inherit"> </span></span>Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [</span><span style="color: #333333">https://www.awmf.org/leitlinien/detail/ll/030-089.html</span><span data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}" style="box-sizing: inherit"><span class="ve-pasteprotect">]</span></span></ref>
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{| 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="{&quot;style&quot;:&quot;border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt&quot;}"
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<span class="ve-pasteProtect" style="mso-ansi-language:
<span class="ve-pasteProtect" style="mso-ansi-language:
DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:\nDE&quot;}">intrathekale Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[28</span></span><ref name=":0" /><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">, 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="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span></span>
DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:\nDE&quot;}">intrathekale Applikation </span><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[28</span></span><ref name=":0" /><span class="ve-pasteProtect" style="mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">, 32</span></span><ref><span style="color: #333333">32. <span class="ve-pasteprotect"><span data-ve-attributes="{&quot;style&quot;:&quot;mso-tab-count:1&quot;}" style="box-sizing: inherit">          <span style="box-sizing: inherit"> </span></span></span>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="{&quot;style&quot;:&quot;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span></span>
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{| 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="{&quot;style&quot;:&quot;border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt&quot;}"
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===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Kalkulierte Therapie</span> ===
===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Kalkulierte Therapie</span>===
<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[28</span></span><ref name=":0" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">, 31</span></span><ref name=":1" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span></span>
<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[28</span></span><ref name=":0" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">, 31</span></span><ref name=":1" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span></span>


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===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Erregerspezifische Therapie</span> ===
===<span class="ve-pasteProtect" style="font-size:13.5pt; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:Calibri; mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;\nmso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:Calibri;\nmso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}">Erregerspezifische Therapie</span>===
<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[28</span></span><ref name=":0" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">, 31</span></span><ref name=":1" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span></span>
<span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[28</span></span><ref name=":0" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">, 31</span></span><ref name=":1" /><span class="ve-pasteProtect" style="font-size:13.5pt;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:13.5pt;mso-fareast-font-family:\&quot;Times New Roman\&quot;;mso-bidi-font-family:\nCalibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span></span>
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{| 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="{&quot;style&quot;:&quot;border-collapse:collapse;mso-yfti-tbllook:1184;mso-padding-alt:5.65pt 5.4pt 5.65pt 5.4pt&quot;}"
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| 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="{&quot;style&quot;:&quot;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;&quot;}" |Ciprofloxacin
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|- style="mso-yfti-irow:2" data-ve-attributes="{&quot;style&quot;:&quot;mso-yfti-irow:2&quot;}"
| 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="{&quot;style&quot;:&quot;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;&quot;}" |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="{&quot;style&quot;:&quot;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;&quot;}" |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="{&quot;style&quot;:&quot;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;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ceftazidim,  Meropenem, Cefepim, ggf. jeweils in Kombination mit Fosfomycin</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">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="{&quot;style&quot;:&quot;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;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Ceftazidim,  Meropenem, Cefepim, ggf. jeweils in Kombination mit Fosfomycin</span><span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">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="{&quot;style&quot;:&quot;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;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">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="{&quot;style&quot;:&quot;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;&quot;}" |<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Aztreonam  oder</span> Ciprofloxacin
Line 196: 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="{&quot;style&quot;:&quot;font-size:12.0pt;\nline-height:107%;mso-ansi-language:DE&quot;}">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="{&quot;style&quot;:&quot;mso-spacerun:yes&quot;}"> </span></span><span class="ve-pasteProtect" style="font-size:12.0pt;line-height:107%;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;line-height:107%;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[</span></span><span class="ve-pasteProtect" style="font-size:12.0pt;
line-height:107%;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;\nline-height:107%;mso-ansi-language:DE&quot;}">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="{&quot;style&quot;:&quot;mso-spacerun:yes&quot;}"> </span></span><span class="ve-pasteProtect" style="font-size:12.0pt;line-height:107%;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;line-height:107%;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">[</span></span><span class="ve-pasteProtect" style="font-size:12.0pt;
line-height:107%;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;\nline-height:107%;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-spacerun:yes&quot;}">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="{&quot;style&quot;:&quot;font-size:12.0pt;line-height:107%;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span>. Diese Erkenntnisse konnten noch nicht in die aktuellen Leitlinien aufgenommen werden.</span>
line-height:107%;mso-ansi-language:DE" data-ve-attributes="{&quot;style&quot;:&quot;font-size:12.0pt;\nline-height:107%;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-spacerun:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-spacerun:yes&quot;}">33</span></span><ref><span style="color: #333333">33. <span class="ve-pasteprotect"><span data-ve-attributes="{&quot;style&quot;:&quot;mso-tab-count:1&quot;}" style="box-sizing: inherit">          <span style="box-sizing: inherit"> </span></span></span>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="{&quot;style&quot;:&quot;font-size:12.0pt;line-height:107%;mso-ansi-language:DE&quot;}"><span class="ve-pasteProtect" style="mso-no-proof:yes" data-ve-attributes="{&quot;style&quot;:&quot;mso-no-proof:yes&quot;}">]</span>. Diese Erkenntnisse konnten noch nicht in die aktuellen Leitlinien aufgenommen werden.</span>
<br />
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<references />

Revision as of 12:45, 25 May 2021

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, 31][1][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

[28[1], 31[2]]

Vancomycin PLUS Meropenem

Alternative Meropenem: Ceftazidim oder Cefepim (im Falle eines operativen Zugangs durch Schleimhäute PLUS Metronidazol)

Alternative Vancomycin: Linezolid (cave: bakteriostatisch)

Erregerspezifische Therapie

[28[1], 31[2]]

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. ↑ 1.0 1.1 1.2 1.3 28.            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. ↑ 2.0 2.1 2.2 31.            Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter, AWMF-Registernummer: 030/089 [https://www.awmf.org/leitlinien/detail/ll/030-089.html]
  3. ↑ 32.            Nau R, Blei C, Eiffert H: Intrathecal Antibacterial and Antifungal Therapies. Clin Microbiol Rev 2020; 33(3)
  4. ↑ 33.            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
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