Kalkulierte Antibiotikatherapie bei intraabdominellen Infektionen – Fallbeispiele und evidenzbasierte Therapieempfehlungen

Zusammenfassung

Intraabdominelle Infektionen (IAI) stellen in der Viszeralmedizin ein häufiges Problem dar. So werden in Deutschland pro Jahr mehr als 150 000 Patienten mit diesem Krankheitsbild behandelt. Dabei kann der Verlauf bei Betroffenen relativ blande sein; intraabdominelle Infektionen können aber auch schwerwiegend verlaufen. Sie bilden z. B. den zweithäufigsten Fokus bei der Sepsis bzw. dem septischen Schock und stellen die zweithäufigste Ursache für das infektionsbedingte Versterben auf der Intensivstation dar. Aufgrund zunehmender Resistenzen von Mikroorganismen, aber auch Veränderungen im Erregerspektrum und zunehmender Komorbiditäten der Patienten müssen Empfehlungen zur initialen kalkulierten Antibiotikatherapie ständig angepasst werden. Eine inadäquate Antibiotikatherapie der IAI verschlechtert substanziell die Prognose der betroffenen Patienten, zu „breite“ Behandlungen verschärfen aber mittelfristig die Resistenzproblematik. In dieser Übersicht werden – basierend auf nationalen und internationalen Leitlinien – an konkreten Beispielen typischer intraabdomineller Infektionen Empfehlungen zur Initialtherapie gegeben. Unter Berücksichtigung lokaler Resistenzraten und individueller patientenspezifischer Faktoren soll damit eine Basis für eine verbesserte Therapie dieses häufigen Problems geschaffen werden.

Abstract

Intra-abdominal infections (IAI) are a common problem in visceral medicine. In Germany more than 150 000 patients are treated each year for IAI with courses ranging from uncomplicated disease to severe life-threatening manifestations. IAI represent the second most common cause of septic shock and the second most common cause of infection-related mortality in intensive care. Due to increasing antimicrobial resistance, changes in pathogen spectra and increasing patient co-morbidities, recommendations for empirical antibiotic therapy have to be continuously updated: Whereas inadequate empirical treatment is associated with poor prognosis, unselected broad-spectrum therapy may increase antimicrobial resistances. Illustrated by clinical cases of typical intra-abdominal infections, this article reviews recommendations for antibiotic therapy based on national and international guidelines under consideration of local resistance rates and patient-specific factors to provide a basis for improved therapy of this common problem.

Schlüsselwörter

infektiöse Kolitis - Morbus Crohn - Leberzirrhose - Abszess - intrabdominelle Infektion

Key words

infectious colitis - Crohn’s disease - liver cirrhosis - abscess - intra-abdominal infections

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