Download PDF
Krankenhaushygiene up2date 2008; 3(4): E1-E23
DOI: 10.1055/s-2008-1077710
Antibiotikaanwendung

© Georg Thieme Verlag KG Stuttgart · New York

Perioperative Antibiotikaprophylaxe (PAP) – Entwicklung und derzeitiger Stand

Lutz  Thomas
Further Information

Publication History

Publication Date:
27 November 2008 (online)

Also available at
    Permissions and Reprints All articles of this category

Kernaussagen

Die perioperative Antibiotikaprophylaxe (PAP) bei zahlreichen Operationen in den Kategorien „sauber”, „sauber-kontaminiert” und ganz besonders „kontaminiert” gehört inzwischen zu den gesicherten Maßnahmen zur Prävention postoperativer Wundinfektionen. Es ist nicht Aufgabe der PAP, andere nosokomiale Infektionen, z. B. Pneumonien und Harnwegsinfektionen, zu verhüten.

Das ausgewählte Antibiotikum soll parenteral innerhalb von 60 Minuten vor Operationsbeginn und nicht länger als über 24 Stunden verabreicht werden.

Zu den bewährten Wirkstoffen zählen die einander gleichwertigen Erst- und Zweitgenerationscephalosporine (Cefazolin und Cefuroxim), die bei Operationen im Bauchraum durch Metronidazol ergänzt werden. Alternativpräparate in der Abdominalchirurgie sind Aminopenicilline plus Beta-Laktamaseinhibitoren. Für einige Fälle bieten sich auch Clindamycin und Glykopeptidantibiotika (Vancomycin, Teicoplanin) an. Ihr Einsatz bleibt jedoch besonderen Situationen (z. B. Penicillin-/Cephalosporinallergie oder nachweisliche Kolonisation des Patienten mit einem multiresistenten Staphylococcus aureus-Stamm) vorbehalten. Ein breiter Einsatz der Glykopeptidantibiotika verbietet sich auch weiterhin trotz einer deutlichen Zunahme von gegen Oxacillin resistenten Staphylococcus aureus-Stämmen in zahlreichen chirurgischen Zentren wegen der begründeten Gefahr, gegen diese Wirkstoffklasse resistente Enterokokken und Staphylokokken zu selektieren. Zudem haben sich weder Clindamycin noch Vancomycin bzw. Teicoplanin gegenüber den älteren Cephalosporinen in der perioperativen Antibiotikaprophylaxe als überlegen erwiesen. Sie verhindern nicht mehr postoperative Wundinfektionen als die empfohlenen Cephalosporinantibiotika.

Literatur

  • 1 Garlock J H, Seley G P. The use of sulfonamide in surgery of the colon and rectum.  Surgery. 1939;  5 787-790
    Google Scholar
  • 2 Kittle C, Reed W. Antibiotics and extracorporeal circulation.  J Thorac Cardiovasc Surg. 1961;  41 34-48
    Google Scholar
  • 3 Altemeier W A, Culbertson W R, Hummel R P. Surgical considerations of endogenous infections – sources, types, and methods of control.  Surg Clin N Amer. 1968;  48 227-240
    Google Scholar
  • 4 Kaiser A B. Antimicrobial prophylaxis in surgery.  N Engl J Med. 1986;  315 1129-1138
    Google Scholar
  • 5 Burke J. The effective period of preventive antibiotic action in experimental incisions and dermal lesions.  Surgery. 1961;  50 161-168
    Google Scholar
  • 6 ASHP Commission on Therapeutics . ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery.  Clin Pharm. 1992;  11 483-513
    Google Scholar
  • 7 Daschner F. Antibiotikaprophylaxe – sinnvoll oder sinnlos?.  Dtsch Med Wochenschr. 1981;  106 1150-1153
    Article in Thieme ConnectGoogle Scholar
  • 8 Burke J. Infection control – a problem for patient safety.  N Engl J Med. 2003;  348 651-656
    CrossrefGoogle Scholar
  • 9 Bratzler D, Houck P. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project.  Clin Infect Dis. 2004;  38 1706-1715
    CrossrefGoogle Scholar
  • 10 Mekontso-Dessap A, Kirsch M. et al . Poststernotomy mediastinitis due to staphylococcus aureus: comparison of methicillin-resistant and methicillin-susceptible cases.  Clin Iinfect Dis. 2001;  32 877-883
    CrossrefPubMedGoogle Scholar
  • 11 Garey K W. et al . Interrupted time series analysis of vancomycin compared to cefuroxime for surgical prophylaxis in patients undergoing cardiac surgery.  Antimicrob Agents Chemother. 2008;  52 446-451
    CrossrefGoogle Scholar
  • 12 Gorbach S. The role of cephalosporins in surgical prophylaxis.  J Antimicrob Chemother. 1989;  23 (Suppl.) 61-70
    Google Scholar
  • 13 Classen D, Evans R, Pestotnik S. et al . The timing of prophylactic administration of antibiotics and the risk of surgical wound infection.  N Engl J Med. 1992;  326 281-286
    CrossrefGoogle Scholar
  • 14 Conte J, Cohen S, Roe B. et al . Antibiotic prophylaxis and cardiac surgery: a prospective double-blind comparison of single-dose versus multiple-dose regimens.  Ann Intern Med. 1972;  76 943-949
    Google Scholar
  • 15 Nooyen S, Overbeek B, Brutel d e. et al . Prospective randomized comparing of single-dose versus multiple-dose cefuroxime for prophylaxis in coronary artery bypass grafting.  Eur J Clin Microbiol Infect Dis. 1994;  13 1033-1037
    CrossrefGoogle Scholar
  • 16 Ebner W, Forster D H, Rüden H, Daschner F. Evidenzbasierte Empfehlungen zur perioperativen Antibiotikaprophylaxe.  Chirurg. 2000;  71 912-917
    CrossrefGoogle Scholar
  • 17 Ayliffe G AJ. Role of the environment of the operating suite in surgical wound infection.  Rev Infect Dis. 1991;  13 (Suppl.) S800-S804
    Google Scholar
  • 18 Rosin H. Antibiotikaprophylaxe in der operativen Gynäkologie und Geburtshilfe aus der Sicht des Mikrobiologen. Operative Gynäkologie.  Berlin, Heidelberg:. Springer-Verlag;  1986 168-175
    Google Scholar
  • 19 National Academy of Science National Research Council, Division of Medical Sciences, Ad Hoc Committee on Trauma . Post-operative wound infections: The influence of ultraviolet irradiation of the operating room and various other factors.  Ann Surg. 1964;  160 (Suppl. 2) 19-31
    Google Scholar
  • 20 Robert-Koch-Institut .Definition nosokomialer Infektionen (CDC-Definitionen). 6. Aufl. Berlin; 2008
    Google Scholar
  • 21 Lord J, Imparato A, Hackel A. et al . Endocarditis complicating open-heart surgery.  Circulation. 1961;  23 489-497
    Google Scholar
  • 22 Goodman J, Schaffner W, Collins H. et al . Infection after cardiovascular surgery.  N Engl J Med. 1968;  278 117-123
    Google Scholar
  • 23 Fekety F, Cluff L, Sabiston D. et al . A study of antibiotic prophylaxis in cardiac surgery.  J Thorac Cardiovasc Surg. 1969;  57 757-763
    Google Scholar
  • 24 Firor W. Infection following open-heart surgery, with special reference to the role of prophylactic antibiotics.  J Thorac Cardiovasc Surg. 1967;  53 371-378
    Google Scholar
  • 25 Neu H. Prophylaxis – has it at last come of age?.  J Antimicrob Chemother. 1979;  5 331-333
    CrossrefGoogle Scholar
  • 26 Cruse P, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62 939 wounds.  Surg Clin N Amer. 1980;  60 27-40
    Google Scholar
  • 27 Mangram A J, Horan T C, Pearson M L, Silver L C, Jarvis W R. the Hospital Infection Control Practices Advisory Committee . Guideline for the prevention of surgical site infection.  Infect Control Hosp Epidemiol. 1999;  20 247-280
    CrossrefGoogle Scholar
  • 28 Dellinger E, Gross P, Barrett T. et al . Quality standard for antimicrobial prophylaxis in surgical procedures.  Clin Infect Dis. 1994;  18 422-427
    Google Scholar
  • 29 Gross P, Barrett T, Dellinger E. et al . Purpose of quality standards for infectious diseases.  Clin Infect Dis. 1994;  18 421
    Google Scholar
  • 30 Garrod L P. Present position of the chemotherapy of bacterial infections.  Brit Med J. 1955;  2 (4942) 756-758
    CrossrefGoogle Scholar
  • 31 Freiman J A. et al . The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial.  N Engl J Med. 1978;  299 690-694
    Google Scholar
  • 32 Kelly M J, Wadsworth J. What price inconclusive clinical trials?.  Annals of the Royal College of Surgeons of England. 1993;  75 145-146
    Google Scholar
  • 33 Washington II J A. et al . Effect of preoperative antibiotic regimen on development of infection after intestinal surgery.  Ann Surg. 1974;  180 567-571
    Google Scholar
  • 34 Bartlett S P, Burton R C. Effects of prophylactic antibiotics on wound infection after elective colon and rectal surgery: 1960 to 1980.  Amer J Surg. 1983;  145 300-309
    CrossrefGoogle Scholar
  • 35 Stone H H. et al . Antibiotic prophylaxis in gastric, biliary and colonic surgery.  Ann Surg. 1976;  184 443-450
    CrossrefGoogle Scholar
  • 36 Austin T, Coles J, Burnett R. et al . Aorta-coronary bypass procedures and sternotomy infections: a study of antistaphylococcal prophylaxis.  Can J Surg. 1980;  23 483-485
    Google Scholar
  • 37 Peters G. Perioperative Antibiotikaprophylaxe in der Chirurgie.  Dtsch Med Wochenschr. 1987;  112 644-646
    Article in Thieme ConnectGoogle Scholar
  • 38 Anonym . Antibiotikaprophylaxe in der Chirurgie.  Der Arzneimittelbrief. 1994;  28 17-21
    Google Scholar
  • 39 Adam D, Daschner F. Infektionsverhütung bei operativen Eingriffen. Stuttgart; Wissenschaftliche Verlagsgesellschaft mbH 1993
    Google Scholar
  • 40 Slonim R, Litwak R, Gadboys H. et al . Antibiotic prophylaxis of infection complicating open-heart operations.  Antimicrob Agents Chemother. 1963;  3 731-735
    Google Scholar
  • 41 Dodds Ashley E, Carroll D. et al . Risk factors for postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus.  Clin Infect Dis. 2004;  38 1555-1560
    CrossrefGoogle Scholar
  • 42 Fong I, Baker C, McKee D. The value of prophylactic antibiotics in aorta-coronary bypass operations.  J Thorac Cardiovasc Surg. 1979;  78 908-913
    Google Scholar
  • 43 Penketh A, Wansbrough-Jones M, Wright E. et al . Antibiotic prophylaxis for coronary artery bypass graft surgery.  Lancet. 1985;  1 1500
    Google Scholar
  • 44 Chodak G W, Plaut M E. Use of systemic antibiotics for prophylaxis in surgery.  Arch Surg. 1977;  112 326-334
    Google Scholar
  • 45 Garibaldi R A. et al . Risk factors for postoperative infection.  Amer J Med. 1991;  91 (Suppl. 3B) S158-S163
    Google Scholar
  • 46 Kujath P. et al . Neues in der perioperativen antibiotischen Prophylaxe.  Chirurg. 2006;  77 490-498
    CrossrefGoogle Scholar
  • 47 Herr R, Starr A, McCord C. et al . Special problems following valve replacement.  Ann Thorac Surg. 1965;  1 403-415
    Google Scholar
  • 48 Lorentzen J E. et al . Vascular graft infection: An analysis of sixty-two graft infections in 2411 consecutively implanted synthetic vascular grafts.  Surgery. 1985;  98 81-86
    Google Scholar
  • 49 Richet H M. et al . Analysis of risk factors for surgical wound infections following vascular surgery.  Amer J Med. 1991;  91 (Suppl. 3B) S170-S172
    Google Scholar
  • 50 Hopkins C C. Antibiotic prophylaxis in clean surgery: peripheral vascular surgery, noncardiovascular thoracic surgery, herniorrhaphy, and mastectomy.  Rev Infect Dis. 1991;  13 (Suppl. 10) S869-S873
    Google Scholar
  • 51 Norden C W. Antibiotic prophylaxis in orthopedic surgery.  Rev Infect Dis. 1991;  13 (Suppl. 10) S842-846
    Google Scholar
  • 52 Nagachinta T, Stephens M, Reitz B. et al . Risk factors for surgical-wound infection following cardiac surgery.  J Infect Dis. 1987;  156 967-73
    Google Scholar
  • 53 Conklin C, Gray R, Neilson D. et al . Determinants of wound infection incidence after isolated coronary artery bypass surgery in patients randomized to receive prophylactic cefuroxime or cefazolin.  Ann Thorac Surg. 1988;  46 172-177
    Google Scholar
  • 54 Hayward G W. Infective endocarditis: a changing disease II.  Brit Med J. 1973;  2 (5869) 764-766
    CrossrefGoogle Scholar
  • 55 Goldmann D, Hopkins C, Karchmer A. et al . Cephalothin prophylaxis in cardiac valve surgery; a prospective, double-blind comparison of two-day and six-day regimens.  J Thorac Cardiovasc Surg. 1977;  73 470-479
    Google Scholar
  • 56 Song F, Glenny A-M. Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials.  Brit J Surg. 1998;  85 1232-1241
    CrossrefGoogle Scholar
  • 57 Akl B, Richardson G. Serum cefazolin levels during cardiopulmonary bypass.  Ann Thorac Surg. 1980;  29 109-112
    Google Scholar
  • 58 Austin T, Coles J, McKechnie P. et al . Cephalothin prophylaxis and valve replacement.  Ann Thorac Surg. 1977;  23 333-336
    Google Scholar
  • 59 Bryan C, Smith C, Sutton J. et al . Comparison of cefamandole and cefazolin during cardiopulmonary bypass.  J Thorac Cardiovasc Surg. 1983;  86 222-225
    Google Scholar
  • 60 Kini P, Fernandez J, Causay R. et al . Double-blind comparison of cefazolin and cephalothin in open-heart surgery.  J Thorac Cardiovasc Surg. 1978;  76 506-509
    Google Scholar
  • 61 Bain W, McGeachie J, Lindsay G. et al . The use of cephalothin sodium (keflin) as the prophylactic antibiotic for open heart surgery.  J Antimicrob Chemother. 1977;  3 339-345
    CrossrefGoogle Scholar
  • 62 Peterson L, Gerding D, Fasching C. Effects of method of antibiotic administration on extravascular penetration: cross-over study of cefazolin given by intermittent injection or constant infusion.  J Antimicrob Chemother. 1981;  7 71-79
    CrossrefGoogle Scholar
  • 63 Wyatt T, Ferguson W, Wilson T. et al . Gentamicin resistant Staphylococcus aureus associated with the use of topical gentamicin.  J Antimicrob Chemother. 1977;  3 213-217
    CrossrefGoogle Scholar
  • 64 Gentry L, Zeluff B, Cooley D. Antibiotic prophylaxis in open-heart surgery: A comparison of cefmandole, cefuroxime, and cefazolin.  Ann Thorac Surg. 1988;  46 167-171
    Google Scholar
  • 65 Kaiser A, Petracek M, Lea I VJ. et al . Efficacy of cefazolin, cefamandole, and gentamicin as prophylactic agents in cardiac surgery.  Ann Surg. 1987;  206 791-797
    Google Scholar
  • 66 Meyerowitz P, Caswell K, Lindsay W. et al . Antibiotic prophylaxis for open-heart surgery.  J Thorac Cardiovasc Surg. 1977;  73 625-629
    Google Scholar
  • 67 Slama T, Sklar S, Misinski J. et al . Randomized comparison of cefamandole, cefazolin and cefuroxime prophylaxis in open-heart surgery.  Antimicrob Agents Chemother. 1986;  29 744-747
    Google Scholar
  • 68 Soteriou M, Recker F, Geroulanos S. et al . Perioperative antibiotic prophylaxis in cardiovascular surgery: A prospective randomized comparative trial of cefazolin versus ceftriaxone.  World J Surg. 1989;  13 798-802
    CrossrefGoogle Scholar
  • 69 Hillis D, Rosenfeldt F, Spicer W. et al . Antibiotic prophylaxis for coronary bypass grafting.  J Thorac Cardiovasc Surg. 1983;  86 217-221
    Google Scholar
  • 70 Finkelstein R, Rabino G. et al . Vancomycin versus cefazolin prophylaxis for cardiac surgery in the setting of a high prevalence of methicillin-resistant staphylococcal infections.  J Thorac Cardiovasc Surg. 2002;  123 326-332
    CrossrefPubMedGoogle Scholar
  • 71 Rüden H, Gastmeier P, Daschner F. et al . Nosocomial and community-acquired infections in Germany. Summary of the results of the first national prevalence study (NIDEP).  Infection. 1997;  25 199-202
    CrossrefGoogle Scholar
  • 72 Kreter B, Woods M. Antibiotic prophylaxis for cardiothoracic operations.  J Thorac Cardiovasc Surg. 1992;  104 590-599
    Google Scholar
  • 73 Joyce F S, Szczepanski K P. A double-blind comparative study of prophylactic antibiotic therapy in open heart surgery: Penicillin G versus vancomycin.  Thorac Cardiovasc Surg. 1986;  34 100-103
    Article in Thieme ConnectGoogle Scholar
  • 74 Doebbeling B, Pfaller M, Kuhns K. et al . Cardiovascular surgery prophylaxis: a randomized, controlled comparison of cefazolin and cefuroxime.  J Thorac Cardiovasc Surg. 1990;  99 981-989
    Google Scholar
  • 75 Geroulanos S, Oxelbark S, Donfried B. et al . Antimicrobial prophylaxis in cardiovascular surgery.  Thorac Cardiovasc Surg. 1987;  35 199-203
    Article in Thieme ConnectGoogle Scholar
  • 76 Wilson A, Treasure T, Gruneberg R. et al . Antibiotic prophylaxis in cardiac surgery: a prospective comparison of two dosage regimens of teicoplanin with a combination of flucloxacillin and tobramycin.  J Antimicrob Chemother. 1988;  21 213-223
    CrossrefGoogle Scholar
  • 77 Bolon M, Morlote M. et al . Glycopeptides are no more effective than β-lactam agents for prevention of surgical site infection after cardiac surgery: A meta-analysis.  Clin Infect Dis. 2004;  38 1357-1363
    CrossrefGoogle Scholar
  • 78 Hospital Infection Control Practices Advisory Committee (HICPAC) . Recommendations for preventing the spread of vancomycin resistance.  Infect Control Hosp Epidemiol. 1995;  16 105-113
    CrossrefGoogle Scholar
  • 79 Johnson A. Intermediate vancomycin resistance in staphylococcus aureus: a major threat or a minor inconvenience?.  J Antimicrob Chemother. 1998;  42 289-291
    CrossrefGoogle Scholar
  • 80 Chang S, Sievert D. et al . Infection with vancomycin-resistant staphylococcus aureus containing the vanA resistance gene.  N Engl J Med. 2003;  348 1342-1347
    CrossrefGoogle Scholar
  • 81 Pien F, Michael N, Mamiya R. et al . Comparative study of prophylactic antibiotics in cardiac surgery – clindamycin versus cephalothin.  J Thorac Cardiovasc Surg. 1979;  77 908-913
    Google Scholar
  • 82 Farrar W, Grambling P. Antistaphylococcal activity and betalactamase resistance of newer cephalosporins.  J Infect Dis. 1976;  133 691-695
    Google Scholar
  • 83 Kreisel D. et al . Surgical antibiotic prophylaxis and clostridium difficile toxin positivity.  Arch Surg. 1995;  130 989-993
    Google Scholar
  • 84 Kappstein I. Die Luft als Erregerreservoir für postoperative Wundinfektionen. Teil 1.  Krankenh.hyg.up2date. 2007;  2 53-68
    Google Scholar
  • 85 Kappstein I. Die Luft als Erregerreservoir für postoperative Wundinfektionen. Teil 2.  Krankenh.hyg.up2date. 2007;  2 161-184
    Google Scholar

Dr. med. Lutz Thomas

Institut für Medizinische Mikrobiologie und Krankenhaushygiene
Heinrich-Heine-Universität

Gebäude 22.21
Moorenstr. 5
40225 Düsseldorf

Email: Lutz.Thomas@uni-duesseldorf.de

      >