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DOI: 10.1055/s-0042-108848
Multiresistente Erreger – Therapiestrategien[*]
Publication History
Publication Date:
10 June 2016 (online)
![](https://www.thieme-connect.de/media/krankenhaushygiene-u2d/201602/lookinside/thumbnails/167_10-1055-s-0042-108848-1.jpg)
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Für schwere Infektionen durch MRSA stehen die Glykopeptide, Linezolid, Daptomycin und die 5. Generation-Cephalosporine zu Verfügung.
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Bei leichten MRSA-Infektionen sind Cotrimoxazol und Doxycyclin orale Therapiealternativen.
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Rifampicin ist ein möglicher Kombinationspartner bei Biofilm-assoziierten MRSA-Infektionen.
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Rifampicin und Fosfomycin sollten wegen der schnellen Resistenzentwicklung nicht als Monotherapie eingesetzt werden.
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Antibotika mit VRE-Wirksamkeit sind Linezolid, Daptomycin, Tigecyclin, Tedizolid und die neuen Lipoglykopeptide.
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Tigecyclin hat ein breites Spektrum im grampositiven und gramnegativen Bereich, ist aber zur Monotherapie von schweren nosokomialen Infektionen, insbesondere bei Bakteriämie nicht geeignet.
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Bei unkomplizierten Harnwegsinfektionen durch 3MRGN und 4MRGN sollen orale Carbapenem-sparende Substanzen (z. B. Nitrofurantoin oder Fosfomycin) eingesetzt werden, wenn sie empfindlich getestet sind.
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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.
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Eine neue Alternative bei Pyelonephritis und intraabdominellen Infektionen durch 3MRGN ist Ceftolozan/Tazobactam.
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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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