Multiresistente Erreger – Therapiestrategien

Zusammenfassung

Infektionen durch multiresistente Erreger sind weltweit ein zunehmendes Problem. Bei schweren Infektionen durch MRSA kommen Glykopeptide, Linezolid, Daptomycin oder Cephalosporine der 5. Generation („MRSA-Cephalosporine“) zum Einsatz, mögliche Kombinationspartner sind Fosfomycin und Rifampicin. Therapieoptionen für VRE-Infektionen sind beschränkt auf Linezolid, Tedizolid, Daptomycin und Tigecyclin. Neue Substanzen mit Wirksamkeit gegen MRSA und VRE sind Tedizolid, Dalbvancin und Oritavancin. Als Monotherapie bei schweren Infektionen durch 3MRGN stehen insbesondere die Carbapeneme zur Verfügung. Ceftolozan/Tazobactam wurde rezent auch in Europa zugelassen und zeigt gute Wirksamkeit gegen einen Großteil der ESBL-Bildner. Bei unkompliziertem Harnwegsinfekt können orale Substanzen wie Nitrofurantoin oder Fosfomycin eingesetzt werden. Gegenüber Carbapenem-resistenten Enterobacteriaceae zeigt Colistin die beste in vitro Empfindlichkeit, gefolgt von Fosfomycin und Tigecyclin. Bei schweren Infektionen durch 4MRGN wird eine Colistin-basierte Kombinationstherapie mit zwei bis drei Substanzen empfohlen, wobei hier als Kombinationspartner auch Carbapeneme sinnvoll sein können.

Abstract

Infections with multi-drug resistant bacteria are increasing worldwide. Glycopeptides, linezolid, daptomycin and 5th generation cephalosporins (“MRSA-cephalsoporins“) are used against severe infections with MRSA, combination partners are rifampin and fosfomycin. Treatment options against VRE-infections are limited to linezolid, daptomycin and tigecyclin. New agents with activity against MRSA and VRE are tedizolid, dalbvancin and oritavancin. For monotherapy of severe infections due to 3MRGN carbapenems are available. Ceftolozane/tazobactam has been licensed by the European Medical Agency and shows good activity against a relevant proportion of ESBL-pathogens. Oral agents such as nitrofurantoin or fosfomycin are used for treatment of uncomplicated cystitis. Colistin shows best in vitro susceptibility against carbapenem-resistant Enterobacteriaceae, followed by fosfomycin and tigecycline. For serious infections with 4MRGN a colistin-based combination treatment with two to three agents is recommended. In such cases a carbapenem as combination partner may be useful.

Schüsselwörter:

MRSA - VRE - MRGN - Extended-Spectrum-Betalaktamase - Carbapenemase

Key words:

MRSA - VRE - MRGN - extended-spectrum beta-lactamase - carbapenemase

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