Multiresistente Erreger im Krankenhaus – Zusammenhang mit Antibiotika in der Tierproduktion?

Behandlungen von Infektionen mit Multiresistenten Erregern (MRE) im Krankenhaus sind ein seit langer Zeit zunehmendes Problem. Besonders bei MRE Enterobakteriazeen häufen sich Infektionen mit nur noch sehr eingeschränkten Therapieoptionen. Im Unterschied zu den in vergangenen Jahrzehnten in der Regel im Krankenhaus erworbenen MRE zeichnet sich eine veränderte Epidemiologie dieser Infektionserreger ab, in Form von zunehmend ambulant erworbenen, in das Krankenhaus hineingetragenen MRE.

Auf Basis neuer Daten werden mögliche Zusammenhänge zwischen Antibiotikagebrauch bei der Aufzucht von Lebensmitteltieren und klinischen Infektionen mit MRE diskutiert. Durch Selektion und Vermehrung in der Tierzucht können MRE über Lebensmittel als Bakterien oder lediglich in Form von Resistenzgenen auf Plasmiden in die kommensale Darmflora des Menschen gelangen. Unter Antibiotikaselektion und nach Überwinden natürlicher Barrieren können MRE als Infektionserreger auftreten. Daraus ergeben sich vielgestaltige Konsequenzen.

Treatment of hospital infections caused by multi-resistant bacterial pathogens (MRBP) has been a growing problem for some time now. Especially multi-resistant enterics cause infections with very limited treatment options. In contrast to past decades of predominantly hospital acquired MRBP, nowadays an epidemiological change is being observed in these pathogens, with an increasing number of MRBP acquired in the community being introduced into the hospital.

Based on recent data, a possible association is discussed between antibiotic use in food animals and clinical infections with MRBP. By selection and amplification in animal husbandry, MRBP can be transferred to the human commensal microbiota via food as bacteria or resistance genes located on plasmids. Under antimicrobial selection pressure and after overcoming natural barriers, MRBP become manifest as infectious pathogens. The consequences are multifaceted.

Key words

Antibiotic resistance - antibiotics in animal breeding - mobile genetic elements - commensal flora - hospital acquired infection - prevention measures

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