DGI:Abdominelle Infektionen/Therapie/Erregerspezifische Therapie: Unterschied zwischen den Versionen

Version vom 9. Juni 2021, 05:12 Uhr

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.

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

@@ Zeile 5: / Zeile 5: @@
 {| class="wikitable MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" width="652"
-|+<span class="col-black">Tabelle 7: Spektren verfügbarer Antiinfektiva</span>
+|+Tabelle 7: Spektren verfügbarer Antiinfektiva
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Präparat</span>
+| style="width:148.8pt;" width="198" |<small>Präparat</small>
-| colspan="16" style="width:340.0pt;" width="453" |<span style="font-size:10.0pt">Erreger</span>
+| colspan="16" style="width:340.0pt;" width="453" |<small>Erreger</small>
 | style="" width="1" |
 |- style="height:275.8ptpx;"
 | style="width:148.8pt;" width="198" valign="top" |
-| style="width:21.25pt;" width="28" |''<span style="font-size:10.0pt">P.  aerugionsa</span>'' <span style="font-size:10.0pt">WT</span>
+| style="width:21.25pt;" width="28" |<small>P.  aerugionsa WT</small>
-| style="width:21.25pt;" width="28" |''<span style="font-size:10.0pt">P.  aeruginosa</span>''<span style="font-size:10.0pt"><span style="mso-spacerun:yes"> </span> AmpC</span>
+| style="width:21.25pt;" width="28" |<small>P.  aeruginosa  AmpC</small>
-| style="width:21.25pt;" width="28" |''P. aeruginosa''<span style="mso-spacerun:yes"> </span> Porinverlust  (oprD-loss)
+| style="width:21.25pt;" width="28" |<small>P. aeruginosa  Porinverlust  (oprD-loss)</small>
-| style="width:21.25pt;" width="28" |''<span style="font-size:10.0pt">P.  aeruginosa</span>''<span style="font-size:10.0pt"><span style="mso-spacerun:yes"> </span> Effluxpumpen</span>
+| style="width:21.25pt;" width="28" |<small>P.  aeruginosa  Effluxpumpen</small>
-| style="width:21.25pt;" width="28" |''P. aeruginosa'' <span style="mso-spacerun:yes"> </span>Carbapenem-R  (Ø Carbapenemase)
+| style="width:21.25pt;" width="28" |<small>P. aeruginosa  Carbapenem-R  (Ø Carbapenemase)</small>
-| style="width:21.4pt;" width="29" |''P. aeruginosa''<span style="mso-spacerun:yes"> </span> MBL+
+| style="width:21.4pt;" width="29" |<small>P. aeruginosa  MBL+</small>
-| style="width:21.25pt;" width="28" |<span style="font-size:10.0pt">Enterobacteriaceae WT</span>
+| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae WT</small>
-| style="width:21.25pt;" width="28" |<span style="font-size:10.0pt">Enterobacteriaceae ESBL+</span>
+| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae ESBL+</small>
-| style="width:21.25pt;" width="28" |<span style="font-size:10.0pt">Enterobacteriaceae OXA-48-like+</span>
+| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae OXA-48-like+</small>
-| style="width:21.25pt;" width="28" |<span style="font-size:10.0pt">Enterobacteriaceae</span><span style="font-size:
+| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae KPC</small>
-.0pt;mso-ansi-language:EN-US"> </span><span style="font-size:10.0pt">KPC</span>
+| style="width:21.25pt;" width="28" |<small>Entero-bacteriaceae  Carbapenem-R (Ø Carbapenemase)</small>
-| style="width:21.25pt;" width="28" |Enterobacteriaceae  Carbapenem-R (Ø Carbapenemase)
+| style="width:21.45pt;" width="29" |<small>Entero-bacteriaceae  MBL+  (VIM,IMP,NDM)</small>
-| style="width:21.45pt;" width="29" |Enterobacteriaceae<span style="mso-spacerun:yes"> </span> MBL+  (VIM,IMP,NDM)
+| style="width:21.25pt;" width="28" |<small>Acinetobacter  baumannii WT</small>
-| style="width:21.25pt;" width="28" |<span style="mso-spacerun:yes"> </span>''Acinetobacter  baumannii'' WT
+| style="width:21.25pt;" width="28" |<small>Acinetobacter  baumannii Carbapenem-R</small>
-| style="width:21.25pt;" width="28" |<span style="mso-spacerun:yes"> </span>''Acinetobacter  baumannii'' Carbapenem-R
+| style="width:21.25pt;" width="28" |<small>Steno-trophomonas maltophilia WT</small>
-| style="width:21.25pt;" width="28" |''<span style="mso-spacerun:yes"> </span> Stenotrophomonas maltophilia'' WT
+| colspan="2" style="width:21.4pt;" width="29" |<small>Steno-trophomonas maltophilia Carbapenem-R</small>
-| colspan="2" style="width:21.4pt;" width="29" |''<span style="mso-spacerun:yes"> </span> Stenotrophomonas maltophilia'' Carbapenem-R
 |- style="height:17.0ptpx;"
-| style="width:148.8pt;" width="198" |Ceftazidim/ Avibactam
+| style="width:148.8pt;" width="198" |<small>Ceftazidim/ Avibactam</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-white-bg" width="28" |
@@ Zeile 47: / Zeile 46: @@
 | colspan="2" style="width:21.4pt;" class="col-red-bg" width="29" |
 |- style="height:17.0ptpx;"
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Ceftolozan/  Tazobactam</span>
+| style="width:148.8pt;" width="198" |<small>Ceftolozan/  Tazobactam</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-green-bg" width="28" |
@@ Zeile 65: / Zeile 64: @@
 | colspan="2" style="width:21.4pt;" class="col-red-bg" width="29" |
 |- style="height:17.0ptpx;"
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Imipenem/  Relebactam</span>
+| style="width:148.8pt;" width="198" |<small>Imipenem/  Relebactam</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-green-bg" width="28" |
@@ Zeile 83: / Zeile 82: @@
 | colspan="2" style="width:21.4pt;" class="col-red-bg" width="29" |
 |- style="height:17.0ptpx;"
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Meropenem/ Varbobactam</span>
+| style="width:148.8pt;" width="198" |<small>Meropenem/ Varbobactam</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-green-bg" width="28" |
@@ Zeile 101: / Zeile 100: @@
 | colspan="2" style="width:21.4pt;" class="col-red-bg" width="29" |
 |- style="height:17.0ptpx;"
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Colisitin</span>
+| style="width:148.8pt;" width="198" |<small>Colisitin</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-green-bg" width="28" |
@@ Zeile 119: / Zeile 118: @@
 | colspan="2" style="width:21.4pt;" class="col-white-bg" width="29" |
 |- style="height:17.0ptpx;"
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Cefiderocol</span>
+| style="width:148.8pt;" width="198" |<small>Cefiderocol</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-green-bg" width="28" |
@@ Zeile 137: / Zeile 136: @@
 | colspan="2" style="width:21.4pt;" class="col-green-bg" width="29" |
 |- style="height:17.0ptpx;"
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Ceftobiprol</span>
+| style="width:148.8pt;" width="198" |<small>Ceftobiprol</small>
 | style="width:21.25pt;" class="col-red-bg" width="28" |
 | style="width:21.25pt;" class="col-red-bg" width="28" |
@@ Zeile 157: / Zeile 156: @@
 <br />
 {| class="wikitable sortable mw-collapsible MsoTableGrid" style="width:100%;" border="1" cellspacing="0" cellpadding="0" width="369"
-|+<span class="ve-pasteProtect" style="font-size:11.0pt;line-height:115%;font-family:&quot;Arial&quot;,sans-serif;
+|+Tabelle 8: Erregerspezifische Antimykotikatherapie bei IAI
-mso-fareast-font-family:Arial;mso-ansi-language:DE;mso-fareast-language:EN-US;
+| style="width:148.8pt;" width="198" |<small>Präparat</small>
-mso-bidi-language:AR-SA" data-ve-attributes="{&quot;style&quot;:&quot;font-size:11.0pt;line-height:115%;font-family:\&quot;Arial\&quot;,sans-serif;\nmso-fareast-font-family:Arial;mso-ansi-language:DE;mso-fareast-language:EN-US;\nmso-bidi-language:AR-SA&quot;}"> </span><span class="col-black">Tabelle 8: Erregerspezifische Antimykotikatherapie bei IAI</span>
+| colspan="6" style="width:127.6pt;" width="170" |<small>Erreger</small>
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt;mso-ascii-font-family:Arial;mso-ascii-theme-font:
-  major-latin;mso-hansi-font-family:Arial;mso-hansi-theme-font:major-latin;
-  mso-bidi-font-family:Arial;mso-bidi-theme-font:major-latin">Präparat</span>
-| colspan="6" style="width:127.6pt;" width="170" |Erreger
 |- style="height:117.15ptpx;"
 | style="width:148.8pt;" width="198" valign="top" |
-| style="width:21.25pt;" width="28" valign="top" |''<span style="font-size:10.0pt">Candida  albicans</span>''
+| style="width:21.25pt;" width="28" valign="top" |<small>Candida  albicans</small>
-| style="width:21.25pt;" width="28" valign="top" |''Candida glabrata''
+| style="width:21.25pt;" width="28" valign="top" |<small>Candida glabrata</small>
-| style="width:21.25pt;" width="28" valign="top" |''Candida parapsilosis''
+| style="width:21.25pt;" width="28" valign="top" |<small>Candida parapsilosis</small>
-| style="width:21.25pt;" width="28" valign="top" |''Candida krusei''
+| style="width:21.25pt;" width="28" valign="top" |<small>Candida krusei</small>
-| style="width:21.25pt;" width="28" valign="top" |''Aspergillus fumigatus''
+| style="width:21.25pt;" width="28" valign="top" |<small>Aspergillus fumigatus</small>
-| style="width:21.35pt;" width="28" valign="top" |''Aspergillus niger''
+| style="width:21.35pt;" width="28" valign="top" |<small>Aspergillus niger</small>
 |- style="height:31.2ptpx;"
-| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Fluconazol</span>
+| style="width:148.8pt;" width="198" valign="top" |<small>Fluconazol</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-white-bg" width="28" |
@@ Zeile 181: / Zeile 176: @@
 | style="width:21.35pt;" class="col-red-bg" width="28" |
 |- style="height:31.2ptpx;"
-| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Voriconazol</span>
+| style="width:148.8pt;" width="198" valign="top" |<small>Voriconazol</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-blue-light-bg" width="28" |
@@ Zeile 189: / Zeile 184: @@
 | style="width:21.35pt;" class="col-green-bg" width="28" |
 |- style="height:31.2ptpx;"
-| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Isavuconazol</span>
+| style="width:148.8pt;" width="198" valign="top" |<small>Isavuconazol</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" valign="top" |
 | style="width:21.25pt;" class="col-blue-light-bg" width="28" valign="top" |
@@ Zeile 197: / Zeile 192: @@
 | style="width:21.35pt;" class="col-green-bg" width="28" valign="top" |
 |- style="height:31.2ptpx;"
-| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Caspofungin</span>
+| style="width:148.8pt;" width="198" valign="top" |<small>Caspofungin</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-green-bg" width="28" |
@@ Zeile 205: / Zeile 200: @@
 | style="width:21.35pt;" class="col-green-bg" width="28" |
 |- style="height:31.2ptpx;"
-| style="width:148.8pt;" width="198" valign="top" |<span style="font-size:10.0pt">Anidulafungin</span>
+| style="width:148.8pt;" width="198" valign="top" |<small>Anidulafungin</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-green-bg" width="28" |
@@ Zeile 213: / Zeile 208: @@
 | style="width:21.35pt;" class="col-green-bg" width="28" |
 |- style="height:17.0ptpx;"
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Micafungin</span>
+| style="width:148.8pt;" width="198" |<small>Micafungin</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-green-bg" width="28" |
@@ Zeile 221: / Zeile 216: @@
 | style="width:21.35pt;" class="col-green-bg" width="28" |
 |- style="height:17.0ptpx;"
-| style="width:148.8pt;" width="198" |<span style="font-size:10.0pt">Liposomales Amphotericin  B</span>
+| style="width:148.8pt;" width="198" |<small>Liposomales Amphotericin  B</small>
 | style="width:21.25pt;" class="col-green-bg" width="28" |
 | style="width:21.25pt;" class="col-green-bg" width="28" |