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

From Infektiopedia
imported>Brinkery
No edit summary
imported>Brinkery
No edit summary
Line 27: Line 27:
|-
|-
!P. aeruginosa  AmpC
!P. aeruginosa  AmpC
!
| class="col-white-bg" |
!
| class="col-green-bg" |
!
| class="col-green-bg" |
!
| class="col-green-bg" |
!
| class="col-green-bg" |
!
| class="col-green-bg" |
!
| class="col-red-bg" |
|-
 
|-
|-
!|P. aeruginosa  Porinverlust (oprD-loss)
!|P. aeruginosa  Porinverlust (oprD-loss)
|
| class="col-white-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|P. aeruginosa  Effluxpumpen
!|P. aeruginosa  Effluxpumpen
|
| class="col-red-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|P. aeruginosa  Carbapenem-R (Ø Carbapenemase)
!|P. aeruginosa  Carbapenem-R (Ø Carbapenemase)
|
| class="col-white-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|P. aeruginosa  MBL+
!|P. aeruginosa  MBL+
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|Entero-bacteriaceae WT
!|Entero-bacteriaceae WT
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|-
|-
!|Entero-bacteriaceae ESBL+
!|Entero-bacteriaceae ESBL+
|
| class="col-green-bg" |
|
| class="col-white-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|Entero-bacteriaceae OXA-48-like+
!|Entero-bacteriaceae OXA-48-like+
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|Entero-bacteriaceae KPC
!|Entero-bacteriaceae KPC
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-white-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|Entero-bacteriaceae Carbapenem-R (Ø Carbapenemase)
!|Entero-bacteriaceae Carbapenem-R (Ø Carbapenemase)
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|
| class="col-white-bg" |
|
| class="col-white-bg" |
|
| class="col-white-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|Entero-bacteriaceae  MBL+ (VIM,IMP,NDM)
!|Entero-bacteriaceae  MBL+ (VIM,IMP,NDM)
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-white-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|Acinetobacter baumannii WT
!|Acinetobacter baumannii WT
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|Acinetobacter baumannii Carbapenem-R
!|Acinetobacter baumannii Carbapenem-R
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
|-
!|Steno-trophomonas maltophilia WT
!|Steno-trophomonas maltophilia WT
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-white-bg" |
|
| class="col-green-bg" |
|
| class="col-green-bg" |
|-
|-
!|Steno-trophomonas maltophilia Carbapenem-R
!|Steno-trophomonas maltophilia Carbapenem-R
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-red-bg" |
|
| class="col-white-bg" |
|
| class="col-green-bg" |
|
| class="col-red-bg" |
|-
 
 
|}
|}
{| class="wikitable MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" width="652"
{| class="wikitable MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" width="652"

Revision as of 10:52, 11 June 2021

Eine Anpassung der antiinfektiven Therapie entsprechend des nachgewiesenen Erregerspektrums sollte so früh wie möglich erfolgen. Tabelle 7 zeigt orientierend die aktuell neu verfügbaren Antiinfektiva für die Therapie von IAI durch MRE. Eine entsprechende Therapie sollte aber immer unter Berücksichtigung des aktuellen Antibiogrammes ausgewählt werden. Tabelle 8 gibt einen Überblick zur erregerspezifischen antimykotischen Therapie.

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

Erreger Präparat
Ceftazidim/ Avibactam Ceftolozan/ Tazobactam Imipenem/ Relebactam Meropenem/ Varbobactam Colisitin Cefiderocol Ceftobiprol
P. aerugionsa WT
P. aeruginosa  AmpC
P. aeruginosa  Porinverlust (oprD-loss)
P. aeruginosa  Effluxpumpen
P. aeruginosa  Carbapenem-R (Ø Carbapenemase)
P. aeruginosa  MBL+
Entero-bacteriaceae WT
Entero-bacteriaceae ESBL+
Entero-bacteriaceae OXA-48-like+
Entero-bacteriaceae KPC
Entero-bacteriaceae Carbapenem-R (Ø Carbapenemase)
Entero-bacteriaceae  MBL+ (VIM,IMP,NDM)
Acinetobacter baumannii WT
Acinetobacter baumannii Carbapenem-R
Steno-trophomonas maltophilia WT
Steno-trophomonas maltophilia Carbapenem-R
Tabelle 7: Spektren verfügbarer Antiinfektiva
Präparat Erreger
P. aerugionsa WT P. aeruginosa  AmpC P. aeruginosa  Porinverlust (oprD-loss) P. aeruginosa  Effluxpumpen P. aeruginosa  Carbapenem-R (Ø Carbapenemase) P. aeruginosa  MBL+ Entero-bacteriaceae WT Entero-bacteriaceae ESBL+ Entero-bacteriaceae OXA-48-like+ Entero-bacteriaceae KPC Entero-bacteriaceae Carbapenem-R (Ø Carbapenemase) Entero-bacteriaceae  MBL+ (VIM,IMP,NDM) Acinetobacter baumannii WT Acinetobacter baumannii Carbapenem-R Steno-trophomonas maltophilia WT Steno-trophomonas maltophilia Carbapenem-R
Ceftazidim/ Avibactam
Ceftolozan/ Tazobactam
Imipenem/ Relebactam
Meropenem/ Varbobactam
Colisitin
Cefiderocol
Ceftobiprol


Tabelle 8: Erregerspezifische Antimykotikatherapie bei IAI
Präparat Erreger
Candida albicans Candida glabrata Candida parapsilosis Candida krusei Aspergillus fumigatus Aspergillus niger
Fluconazol
Voriconazol
Isavuconazol
Caspofungin
Anidulafungin
Micafungin
Liposomales Amphotericin B
Retrieved from "https://wiki.cakele.iodatalabs.dev/index.php?title=DGI:Abdominelle_Infektionen/Therapie/Erregerspezifische_Therapie&oldid=4784"