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Dtsch Med Wochenschr 2006; 131(48): 2726-2732
DOI: 10.1055/s-2006-956298
Übersicht | Review article
Gastroenterologie, Infektiologie
© Georg Thieme Verlag KG Stuttgart · New York

Infektionsprophylaxe bei gastrointestinalen endoskopischen Eingriffen

Control of infection in gastrointestinal endoscopyE. Biecker1 , T. Sauerbruch1
  • 1Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn
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Publication History

eingereicht: 1.6.2006

akzeptiert: 14.9.2006

Publication Date:
22 November 2006 (online)

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Zusammenfassung

Bei endoskopischen Untersuchungen des Gastrointestinaltrakts kommt es häufig zu transienten Bakteriämien, allerdings nur sehr selten zu manifesten Infektionen. Trotzdem wird für ausgewählte Risikopatienten eine Antibiotikaprophylaxe empfohlen. Bei Patienten mit einem hohen Endokarditisrisiko (z. B. Klappenträger, Z.n. vorangegangener Endokarditis, angeborene zyanotische Vitien) sollte eine Antibiotikaprophylaxe mit Amoxicillin (Clindamycin oder Vancomycin bei Penicillinallergie) durchgeführt werden. Auch Patienten mit gestauten Gallengängen, bei denen eine endoskopische retrograde Cholangio-Pankreatikografie (ERCP) durchgeführt wird, sind, genauso wie Patienten vor der Anlage einer perkutanen endoskopischen Gastrostomie (PEG), Kandidaten für eine Antibiotikaprophylaxe. Patienten mit Leberzirrhose und endoskopischer Behandlung einer Ösophagusvarizenblutung benötigen ebenfalls eine antibiotische Therapie. In der Übersicht wird auch auf die Patienten, die keine Prophylaxe benötigen, eingegangen.

Summary

Transient bacteraemia during endoscopic examination of the gastrointestinal tract is well recognized, but infectious complications arising from such transient bacteraemia are rare. Nevertheless, patients at high risk should receive antibiotic prophylaxis. Patients with an increased risk for endocarditis (e. g. patients with a prosthetic heart valve or a history of endocarditis) should receive amoxicillin (clindamycin or vancomycin when allergic to penicillin) prophylactically. In addition, patients with cholestasis undergoing endoscopic retrograde cholangiopancreatography and those before percutaneous endoscopic gastrostomy should receive antibiotic prophylaxis. Patients with cirrhosis of the liver and endoscopic treatment of bleeding esophageal varices should be treated with antibiotics as well. Patients who do not need antibiotic prophylaxis will also be defined in this review.

Schlüsselwörter

Endoskopie - Endokarditis - Antibiotikaprophylaxe - Bakteriämie

Key words

Endoscopy - endocarditis - antibiotic prophylaxis - bakteraemia

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Dr. med. Dr. phil. Erwin Biecker

Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn

Sigmund-Freud-Straße 25

53105 Bonn

Phone: 0228/2875507

Fax: 0228/2874322

Email: erwin.biecker@ukb.uni-bonn.de