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Krankenhaushygiene up2date 2016; 11(02): 187-198
DOI: 10.1055/s-0042-108848
Nosokomiale Infektionen
© Georg Thieme Verlag KG Stuttgart · New York

Multiresistente Erreger – Therapiestrategien[*]

Christina Forstner
,
Mathias W. Pletz
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Publikationsverlauf

Publikationsdatum:
10. Juni 2016 (online)

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Kernaussagen

  • Für schwere Infektionen durch MRSA stehen die Glykopeptide, Linezolid, Daptomycin und die 5. Generation-Cephalosporine zu Verfügung.

  • Bei leichten MRSA-Infektionen sind Cotrimoxazol und Doxycyclin orale Therapiealternativen.

  • Rifampicin ist ein möglicher Kombinationspartner bei Biofilm-assoziierten MRSA-Infektionen.

  • Rifampicin und Fosfomycin sollten wegen der schnellen Resistenzentwicklung nicht als Monotherapie eingesetzt werden.

  • Antibotika mit VRE-Wirksamkeit sind Linezolid, Daptomycin, Tigecyclin, Tedizolid und die neuen Lipoglykopeptide.

  • Tigecyclin hat ein breites Spektrum im grampositiven und gramnegativen Bereich, ist aber zur Monotherapie von schweren nosokomialen Infektionen, insbesondere bei Bakteriämie nicht geeignet.

  • Bei unkomplizierten Harnwegsinfektionen durch 3MRGN und 4MRGN sollen orale Carbapenem-sparende Substanzen (z. B. Nitrofurantoin oder Fosfomycin) eingesetzt werden, wenn sie empfindlich getestet sind.

  • Bei schweren Infektionen durch 3MRGN ist eine Monotherapie der noch wirksamen Antibiotikagruppe ausreichend, in der Regel eine Therapie mit einem Carbapenemen, u. U. auch Piperacillin-Tazobactam.

  • Eine neue Alternative bei Pyelonephritis und intraabdominellen Infektionen durch 3MRGN ist Ceftolozan/Tazobactam.

  • Bei schweren Infektionen durch 4MRGN, insbesondere KPC, scheint eine Kombinationstherapie (z. B. Dreifachkombination mit Colistin-Carbapenem-Tigecyclin oder Fosfomycin) vorteilhaft zu sein.

* Erstveröffentlichung in: Anästhesiol Notfallmed Schmerzther 2016; 51: 126 – 133


 

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