Prophylaxe der Sepsis – Infektionsprävention, Hygienerichtlinien und Akutmanagement

Trotz Einführung neuer diagnostischer und therapeutischer Prinzipien ist die Sterblichkeit der Sepsis unverändert hoch. Die Sepsis ist mit hohen Behandlungskosten assoziiert. Guidelines zum Sepsismanagement fokussieren auf die frühe Diagnostik und effektive Primärtherapie. Während die Flüssigkeitstherapie und Antibiotikagabe weitgehend etabliert sind, existieren verschiedene supportive und adjunktive Therapieansätze, deren Nutzen teilweise noch ungeklärt ist. Ein anderer wesentlicher Ansatz sind effektive prophylaktische Konzepte.

Wesentlich ist die Prophylaxe von Infektionen, auf deren Grundlage eine Sepsis entstehen kann sowie die Infektionskontrolle. Bei den nosokomialen Infektionen sind neben der konsequenten Einhaltung hygienischer Standards insbesondere die Implementierung von multimodularen Programmen mit entsprechender Surveillance und Schulungen wirksam. Eine intensivierte Insulintherapie kann bei kardiochirurgischen Patienten die Sepsisrate reduzieren. Der protektive Effekt von Statinen und niedrig dosiertem Hydrokortison ist bisher nicht ausreichend belegt.

In spite of improved diagnostic and therapeutic strategies, the incidence and mortality rates of sepsis and septic shock are still high and associated with rising cost for the health care systems. Many instructions for the management of sepsis and septic shock have been issued. These treatment guidelines focus on early diagnosis and effective treatment with initial fluid resuscitation and antibiotic selection. Another important approach is the prevention of sepsis. This includes infection prevention by continual surveillance and re–education. A multi–professional team approach is required to to develop and implement strategies to prevent infection of the critically ill patient. Rational use of antibiotic agents and a rigorous hygiene management are indispensable. However, the impact of various preventive strategies, e. g. administration of corticosteroids as well as of insulin and statins remains unclear.

Key words

sepsis - mortality - prophylaxis - hygiene - infection source control

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