Kinder- und Jugendmedizin 2008; 08(02): 101-104
DOI: 10.1055/s-0038-1628955
Infektiologie
Schattauer GmbH

Rezidivierende Staphylococcus aureus- Infektionen

Recurrent Staphylococcus aureus infections
Christian Theilacker
1   Abteilung Infektiologie, Medizin II, Universitätsklinik Freiburg (Leiter: Prof. Dr. med. Winfried V. Kern)
,
Siegbert Rieg
1   Abteilung Infektiologie, Medizin II, Universitätsklinik Freiburg (Leiter: Prof. Dr. med. Winfried V. Kern)
,
Johannes Hübner
1   Abteilung Infektiologie, Medizin II, Universitätsklinik Freiburg (Leiter: Prof. Dr. med. Winfried V. Kern)
,
Winfried V. Kern
1   Abteilung Infektiologie, Medizin II, Universitätsklinik Freiburg (Leiter: Prof. Dr. med. Winfried V. Kern)
› Author Affiliations
Further Information

Publication History

Eingegangen: 01 October 2007

angenommen: 19 October 2007

Publication Date:
25 January 2018 (online)

Zusammenfassung

Rezidive bei S. aureus-Infektionen sind häufig. Wirtsfaktoren, erregerspezifische Pathogenitätsfaktoren, aber auch eine inadäquate Therapie sind hierfür verantwortlich. Sie betreffen Haut- und Weichteilinfektionen ebenso wie Bakteriämien und sind von besonderer Bedeutung bei nichtentfernten oder -entfernbaren Fremdkörpern. Biofilmbildung und sogenannte Small Colony Variants spielen eine wichtige pathogenetische Rolle durch die Induktion von Resistenz gegenüber Antibiotika und körpereigenen antimikrobiellen Substanzen. Eine hoch dosierte Betalaktam- Therapie und ausreichende Therapiedauer sind für gute Behandlungsergebnisse wichtige Faktoren. Eine sorgfältige diagnostische Abklärung von Organabsiedelungen senkt die Rezidivrate der S. aureus-Bakteriämie.

Summary

Recurrent S. aureus infections are a frequent clinical problem. Host factors, virulence factors and inadequate medical therapy may be involved in recurrence of the infection. Skin and soft tissue, bloodstream and foreign body infections account most frequently for recurrent staphylococcal disease. In the setting of biofilm and small colony variants increased resistance against antibiotics as well as endogenous antimicrobial peptides is encountered. Adequate dosage and duration of the antimicrobial and preferred usage of beta lactams improves patient outcome. A thorough diagnostic workup to detect deep seated infection reduces the rate of recurrence in S. aureus bacteremia.

 
  • Literatur

  • 1 Darmstadt GL, Lane AT. Impetigo: an overview. Pediatr Dermatol 1994; 11 (04) 293-303.
  • 2 Schofer H, Brockmeyer N, Dissemond J. et al. [Staphylococcal infections of the skin and mucous membranes. Guideline of the German Dermatologic Society, Study Group of Dermatologic Infectiology]. J Dtsch Dermatol Ges 2005; 3 (09) 726-734.
  • 3 Daum RS. Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus . N Engl J Med 2007; 357 (04) 380-390.
  • 4 Rieg S, Steffen H, Seeber S. et al. Deficiency of dermcidin-derived antimicrobial peptides in sweat of patients with atopic dermatitis correlates with an impaired innate defense of human skin in vivo. J Immunol 2005; 174 (12) 8003-8010.
  • 5 Biedermann T. Dissecting the role of infections in atopic dermatitis. Acta Derm Venereol 2006; 86 (02) 99-109.
  • 6 Fowler Jr VG, Olsen MK, Corey GR. et al. Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 2003; 163 (17) 2066-2072.
  • 7 Jensen AG. Importance of focus identification in the treatment of Staphylococcus aureus bacteraemia. J Hosp Infect 2002; 52 (01) 29-36.
  • 8 Fowler Jr VG, Kong LK, Corey GR. et al. Recurrent Staphylococcus aureus bacteremia: pulsedfield gel electrophoresis findings in 29 patients. J Infect Dis 1999; 179 (05) 1157-1161.
  • 9 Johnson LB, Almoujahed MO, Ilg K. et al. Staphylococcus aureus bacteremia: compliance with standard treatment, long-term outcome and predictors of relapse. Scand J Infect Dis 2003; 35 11–12 782-9.
  • 10 Khatib R, Riederer K, Saeed S. et al. Time to positivity in Staphylococcus aureus bacteremia: possible correlation with the source and outcome of infection. Clin Infect Dis 2005; 41 (05) 594-598.
  • 11 Hartstein AI, Mulligan ME, Morthland VH, Kwok RY. Recurrent Staphylococcus aureus bacteremia. J Clin Microbiol 1992; 30 (03) 670-674.
  • 12 Marr KA, Sexton DJ, Conlon PJ. et al. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 1997; 127 (04) 275-280.
  • 13 Fitzpatrick F, Humphreys H, O‘Gara JP. The genetics of staphylococcal biofilm formation – will a greater understanding of pathogenesis lead to better management of device-related infection?. Clin Microbiol Infect 2005; 11 (12) 967-973.
  • 14 Hall-Stoodley L, Costerton JW, Stoodley P. Bacterial biofilms: from the natural environment to infectious diseases. Nat Rev Microbiol 2004; 2 (02) 95-108.
  • 15 Maira-Litran T, Kropec A, Abeygunawardana C. et al. Immunochemical properties of the staphylococcal poly-N-acetylglucosamine surface polysaccharide. Infect Immun 2002; 70 (08) 4433-4440.
  • 16 Saginur R, Stdenis M, Ferris W. et al. Multiple combination bactericidal testing of staphylococcal biofilms from implant-associated infections. Antimicrob Agents Chemother 2006; 50 (01) 55-61.
  • 17 Zimmerli W, Trampuz A, Ochsner PE. Prostheticjoint infections. N Engl J Med 2004; 351 (16) 1645-1654.
  • 18 Proctor RA, van Langevelde P, Kristjansson M. et al. Persistent and relapsing infections associated with small-colony variants of Staphylococcus aureus . Clin Infect Dis 1995; 20 (01) 95-102.
  • 19 Proctor RA, von Eiff C, Kahl BC. Small colony variants: a pathogenic form of bacteria that facilitates persistent and recurrent infections. Nat Rev Microbiol 2006; 4 (04) 295-305.
  • 20 von Eiff C, Bettin D, Proctor RA. et al. Recovery of small colony variants of Staphylococcus aureus following gentamicin bead placement for osteomyelitis. Clin Infect Dis 1997; 25 (05) 1250-1251.
  • 21 von Eiff C, Peters G, Becker K. The small colony variant (SCV) concept – the role of staphylococcal SCVs in persistent infections. Injury 2006; 37 (02) S26-33.
  • 22 Ausbruch von Furunkeln durch lukS-lukF-positive Staphylococcus aureus in einem Dorf in Brandenburg 2002–2004. Epidemiologisches Bulletin 2005; 10: 79-83.
  • 23 Shastry L, Rahimian J, Lascher S. Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections in men who have sex with men in New York City. Arch Intern Med 2007; 167 (08) 854-7.
  • 24 Miller LG, Quan C, Shay A. et al. A prospective investigation of outcomes after hospital discharge for endemic, community-acquired methicillin-resistant and -susceptible Staphylococcus aureus skin infection. Clin Infect Dis 2007; 44 (04) 483-492.
  • 25 Chang FY, Peacock Jr JE, Musher DM. et al. Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine (Baltimore) 2003; 82 (05) 333-339.
  • 26 Jensen AG, Wachmann CH, Espersen F. et al. Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases. Arch Intern Med 2002; 162 (01) 25-32.
  • 27 Stevens DL. The role of vancomycin in the treatment paradigm. Clin Infect Dis 2006; 42 (01) S51-7.
  • 28 Hidayat LK, Hsu DI, Quist R. et al. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 2006; 166 (19) 2138-2144.