Urosepsis: Aktueller Stand der Therapie

Zusammenfassung

Trotz aller medizinischen Fortschritte der letzten Jahre und Jahrzehnte zeigt die Sepsis und damit auch die Urosepsis eine unverändert hohe Mortalität. Ihre Häufigkeit nimmt aufgrund des höheren Alters der Patienten, vermehrter Anwendung immunsuppressiver Therapien und Zunahme invasiver Maßnahmen zu.

Die Standardbehandlung besteht, nach Sanierung des Sepsisherdes, in der Gabe von Antibiotika, Volumengabe, Vasokonstriktoren, Kortisonapplikation, Immunglobulinen und Korrektur der Gerinnungswerte. Organdysfunktionen werden durch entsprechende Organersatztherapien korrigiert. Allerdings sind nicht alle diese Therapieansätze durch entsprechende Studien in ihrer Wirkung belegt.

Die neuen Erkenntnisse der Pathophysiologie der Sepsis haben bisher noch keine erfolgreichen grundsätzlich neuen Behandlungsstrategien nach sich gezogen. Jedoch ist eine Vielzahl von Untersuchungen auf den Weg gebracht um eine Verbesserung der Therapie der Sepsis und damit eine Reduktion ihrer hohen Mortalität zu erreichen.

Abstract

Despite rapid progress in all fields of medicine in recent years, sepsis and its urological variant, urosepsis still has an unacceptably high mortality. The incidence of sepsis increases with advancing age of the patients, widespread use of immunosuppressive therapy and an intensification of invasive diagnostic and therapeutic measures.

Standard therapy of sepsis consists in drainage of the septic focus, volume substitution, antibiotics, administration of vasoconstrictive agents, corticoids and immunoglobulins and correction of coagulation disorders. Not all of these measures have been sufficiently evaluated to date by appropriate prospective studies. Organ dysfunction is restituted by organ replacement therapy, such as dialysis or artificial ventilation.

New insight into pathophysiological changes during the course of sepsis have not yet translated into new therapeutic measures. However, a wide variety of studies are underway to improve the therapy of sepsis and to help reduce mortality.

Key words:

Sepsis - Urosepsis - Standard therapy - Experimental strategies

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