Antibiotic Stewardship (ABS) im Krankenhaus: ein Update

Dieser Beitrag basiert auf einer früheren Übersicht zu ABS [1]. Er lehnt sich zunächst eng an die Gliederung der aktuellen deutschen S3-Leitlinie „Strategien zur Sicherung rationaler Antibiotika-Anwendung im Krankenhaus“ von 2019 an. Vor allem im klinischen Bereich zu Diagnostik und Therapie gibt er jedoch auch konkrete Empfehlungen – im Sinne „alter Wahrheiten und Tugenden“, aber auch auf Basis neuerer (überwiegend randomisierter) Studien.

• Literatur

• 1 Juzek-Küpper MF, Fussen R, Haverkamp M. et al. Antibiotic Stewardship in der Intensivmedizin. Dtsch Med Wochenschr 2018; 143: 1525-1531
• 2 de With K, Allerberger F, Amann S. et al. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection 2016; 44: 395-439
• 3 Kern WV, Horn S, Fink G. Aktuelle Entwicklungen im Bereich Antibiotic Stewardship. Dtsch Med Wochenschr 2020; 145: 1758-1763
• 4 Dalhoff K, Abele-Horn M, Andreas S. et al. [Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia – Update 2017 – S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology]. Pneumologie 2018; 72: 15-63
• 5 Dinh A, Ropers J, Duran C. et al. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial. Lancet 2021; 397: 1195-1203
• 6 Bernard L, Arvieux C, Brunschweiler B. et al. Antibiotic therapy for 6 or 12 weeks for prosthetic joint infection. N Engl J Med 2021; 384: 1991-2001
• 7 Yahav D, Franceschini E, Koppel F. et al. Seven versus 14 days of antibiotic therapy for uncomplicated gram-negative bacteremia: a noninferiority randomized controlled trial. Clin Infect Dis 2019; 69: 1091-1098
• 8 von Dach E, Albrich WC, Brunel A-S. et al. Effect of C-reactive protein-guided antibiotic treatment duration, 7-day treatment, or 14-day treatment on 30-day clinical failure rate in patients with uncomplicated gram-negative bacteremia: a randomized clinical trial. JAMA 2020; 323: 2160-2169
• 9 Chamat-Hedemand S, Dahl A, Østergaard L. et al. Prevalence of infective endocarditis in streptococcal bloodstream infections is dependent on streptococcal species. Circulation 2020; 142: 720-730
• 10 Dahl A, Iversen K, Tonder N. et al. Prevalence of infective endocarditis in Enterococcus faecalis bacteremia. J Am Coll Cardiol 2019; 74: 193-201
• 11 Holland TL, Raad I, Boucher HW. et al. Effect of algorithm-based therapy vs usual care on clinical success and serious adverse events in patients with staphylococcal bacteremia: a randomized clinical trial. JAMA 2018; 320: 1249-1258
• 12 Rhee C. Using procalcitonin to guide antibiotic therapy. Open Forum Infect Dis 2016; 4: ofw249
• 13 Oliveira CF, Botoni FA, Oliveira CRA. et al. Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med 2013; 41: 2336-2343
• 14 Jensen JU, Heslet L, Jensen TH. et al. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med 2006; 34: 2596-2602
• 15 Jensen JU, Hein L, Lundgren B. et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: A randomized trial. Crit Care Med 2011; 39: 2048-2058
• 16 Azuhata T, Kinoshita K, Kawano D. et al. Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock. Crit Care 2014; 18: R87
• 17 de Vroom SL, van Daalen FV, Zieck SE. et al. Does dose reduction of renally cleared antibiotics in patients with impaired renal function lead to adequate drug exposure? A systematic review. Clin Microbiol Infect 2021; 27: 352-363
• 18 Crass RL, Rodvold KA, Mueller BA. et al. Renal dosing of antibiotics: Are we jumping the gun?. Clin Infect Dis 2019; 68: 1596-1602
• 19 Vardakas KZ, Voulgaris GL, Maliaros A. et al. Prolonged versus short-term intravenous infusion of antipseudomonal β-lactams for patients with sepsis: a systematic review and meta-analysis of randomised trials. Lancet Infect Dis 2018; 18: 108-120
• 20 Jorgensen SCJ, Stewart JJ, Dalton BR. The case for „conservative pharmacotherapy“. J Antimicrob Chemother 2021; 76: 1658-1660
• 21 Hagel S, Fiedler S, Hohn A. et al. Therapeutic drug monitoring-based dose optimisation of piperacillin/tazobactam to improve outcome in patients with sepsis (TARGET): a prospective, multi-centre, randomised controlled trial. Trials 2019; 20: 330
• 22 Williams P, Beall G, Cotta MO. et al. Antimicrobial dosing in critical care: A pragmatic adult dosing nomogram. Int J Antimicrob Agents 2020; 55: 105837
• 23 Scarborough M, Li HK, Rombach I. et al. Oral versus intravenous antibiotics for bone and joint infections: the OVIVA non-inferiority RCT. Health Technol Assess 2019; 23: 1-92
• 24 Molton JS, Chan M, Kalimuddin S. et al. Oral vs intravenous antibiotics for patients with Klebsiella pneumoniae liver abscess: a randomized, controlled noninferiority study. Clin Infect Dis 2020; 71: 952-959
• 25 Iversen K, Ihlemann N, Gill SU. et al. Partial oral versus intravenous antibiotic treatment of endocarditis. N Engl J Med 2019; 380: 415-424
• 26 Kaasch AJ, Rommerskirchen A, Hellmich M. et al. Protocol update for the SABATO trial: a randomized controlled trial to assess early oral switch therapy in low-risk Staphylococcus aureus bloodstream infection. Trials 2020; 21: 175
• 27 MacFadden DR, LaDelfa A, Leen J. et al. Impact of reported beta-lactam allergy on inpatient outcomes: a multicenter prospective cohort study. Clin Infect Dis 2016; 63: 904-910
• 28 Huang K-HG, Cluzet V, Hamilton K. et al. The impact of reported beta-lactam allergy in hospitalized patients with hematologic malignancies requiring antibiotics. Clin Infect Dis 2018; 67: 27-33
• 29 Solensky R, Earl HS, Gruchalla RS. Lack of penicillin resensitization in patients with a history of penicillin allergy after receiving repeated penicillin courses. Arch Intern Med 2002; 162: 822-826
• 30 Trubiano JA, Vogrin S, Chua KYL. et al. Development and validation of a penicillin allergy clinical decision rule. JAMA Intern Med 2020; 180: 745-752
• 31 Wurpts G, Aberer W, Dickel H. et al. S2k-Leitlinie: Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit. Allergo J Int 2019; 28: 121-151
• 32 Evans SE, Jennerich AL, Azar MM. et al. Nucleic Acid-based Testing for Noninfluenza Viral Pathogens in Adults with Suspected Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2021; 203: 1070-1087
• 33 Morgan DJ, Malani P, Diekema DJ. Diagnostic Stewardship – Leveraging the laboratory to improve antimicrobial use. JAMA 2017; 318: 607-608
• 34 Tartof SY, Chen LH, Tian Y. et al. Do Inpatient Antimicrobial Stewardship Programs help us in the battle against antimicrobial resistance?. Clin Infect Dis 2021; 73: e4454-e4462
• 35 Kyriazopoulou E, Liaskou-Antoniou L, Adamis G. et al. Procalcitonin to reduce long-term infection-associated adverse events in sepsis. A randomized trial. . Am J Respir Crit Care Med 2021; 203: 202-210