Perioperative Antibiotikaprophylaxe (PAP) – Entwicklung und derzeitiger Stand

Kernaussagen

Die perioperative Antibiotikaprophylaxe (PAP) bei zahlreichen Operationen in den Kategorien „sauber”, „sauber-kontaminiert” und ganz besonders „kontaminiert” gehört inzwischen zu den gesicherten Maßnahmen zur Prävention postoperativer Wundinfektionen. Es ist nicht Aufgabe der PAP, andere nosokomiale Infektionen, z. B. Pneumonien und Harnwegsinfektionen, zu verhüten.

Das ausgewählte Antibiotikum soll parenteral innerhalb von 60 Minuten vor Operationsbeginn und nicht länger als über 24 Stunden verabreicht werden.

Zu den bewährten Wirkstoffen zählen die einander gleichwertigen Erst- und Zweitgenerationscephalosporine (Cefazolin und Cefuroxim), die bei Operationen im Bauchraum durch Metronidazol ergänzt werden. Alternativpräparate in der Abdominalchirurgie sind Aminopenicilline plus Beta-Laktamaseinhibitoren. Für einige Fälle bieten sich auch Clindamycin und Glykopeptidantibiotika (Vancomycin, Teicoplanin) an. Ihr Einsatz bleibt jedoch besonderen Situationen (z. B. Penicillin-/Cephalosporinallergie oder nachweisliche Kolonisation des Patienten mit einem multiresistenten Staphylococcus aureus-Stamm) vorbehalten. Ein breiter Einsatz der Glykopeptidantibiotika verbietet sich auch weiterhin trotz einer deutlichen Zunahme von gegen Oxacillin resistenten Staphylococcus aureus-Stämmen in zahlreichen chirurgischen Zentren wegen der begründeten Gefahr, gegen diese Wirkstoffklasse resistente Enterokokken und Staphylokokken zu selektieren. Zudem haben sich weder Clindamycin noch Vancomycin bzw. Teicoplanin gegenüber den älteren Cephalosporinen in der perioperativen Antibiotikaprophylaxe als überlegen erwiesen. Sie verhindern nicht mehr postoperative Wundinfektionen als die empfohlenen Cephalosporinantibiotika.

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