Antibiotikatherapie der pyogenen Spondylodiszitis bei Erwachsenen

Christoph Fleege; Michael Rauschmann; Thomas A. Wichelhaus

doi:10.1055/s-0043-117265

Die Wirbelsäule, Inhaltsverzeichnis

Die Wirbelsäule 2017; 01(04): 284-293
DOI: 10.1055/s-0043-117265

Übersicht

Antibiotikatherapie der pyogenen Spondylodiszitis bei Erwachsenen

Antibiotic therapy of pyogenic spondylodiscitis in adults

Christoph Fleege

¹Abteilung für Wirbelsäulenorthopädie, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Frankfurt am Main

,

Michael Rauschmann

¹Abteilung für Wirbelsäulenorthopädie, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Frankfurt am Main

,

Thomas A. Wichelhaus

²Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsklinikum Frankfurt, Frankfurt am Main

› Institutsangaben

Abstract

Zusammenfassung

Für eine erfolgreiche Behandlung der pyogenen Spondylodiszitis ist eine suffiziente Antibiotikatherapie essenziell. Bei hämodynamisch stabilen Patienten mit normalem neurologischem Status sollte mit einer Antibiotikatherapie solange gewartet werden, bis die mikrobiologische Diagnostik einen Erregernachweis mit Antibiogramm erbringt und somit eine gezielte Therapie ermöglicht. Bei hämodynamisch instabilen Patienten oder bei Patienten mit fortschreitenden bzw. schweren neurologischen Symptomen sollte vor der kalkulierten Therapie eine mikrobiologische Diagnostik (Blutkulturen) eingeleitet werden. Empfehlungen zur kalkulierten und gezielten Therapie der pyogenen Spondylodiszitis sind in dieser Arbeit formuliert. In unkomplizierten Verläufen, ohne operative Instrumentation, ist eine systemische Therapiedauer von 6 Wochen ausreichend. Im Rahmen einer operativen Sanierung des Infektherdes stehen lokale Antibiotikaträger auf der Basis von Hydroxylapatit und Kalziumsulfat zur Verfügung.

Abstract

For a successful treatment of pyogenic spondylodiscitis, sufficient antibiotic therapy is essential. In cases with hemodynamically stable patients with normal neurological status, an antibiotic treatment should be withheld until microbiological diagnostics provide antibiotic detection and thus allow adequate therapy. In hemodynamically unstable situations or in patients with progressive or severe neurological symptoms microbiological diagnostics (blood cultures) should be initiated before the calculated therapy is started. Recommendations on the calculated and targeted therapy of pyogenic spondylodiscitis are formulated in this work. In uncomplicated courses, without an instrumentation, a systemic therapy duration of 6 weeks is sufficient. Local antibiotics basing on hydroxylapatite and calcium sulfate are available as part of an surgical sanitation of the infective focus.

Schlüsselwörter

Spondylodiszitis - Antibiotika - Mikrobiologie - lokale Antibiotikatherapie - systemische Antibiotikatherapie

Keywords

spondylodiscitis - antibiotics - microbiology - local antibiotic treatment - systemic antibiotic treatment

Volltext

Referenzen

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