Wundinfektionen durch methicillinresistente Staphylococcus spp. (MRS) bei Kleintieren und Pferden: klinische Bedeutung, Therapie und Prophylaxe

Zusammenfassung:

In den vergangenen Jahrzehnten erlangten verschiedene Populationen von Staphylococcus sp. multiple Resistenzen durch die Akkumulation vielfältiger Resistenzdeterminanten. Heutzutage besitzen Infektionen durch methicillinresistente Staphylococcus sp. (MRS) weltweit sowohl in der Humanmedizin als auch in zunehmendem Maße in Veterinärmedizin große klinische Relevanz. Seit den frühen siebziger Jahren sind MRS-Infektionen bei Tieren bekannt. In den letzten Jahren kam es jedoch zu einem deutlichen Anstieg derartiger Berichte. Insbesondere bei Kleintieren und Pferden treten Infektionen durch MRS auf, und zwar vorrangig in Zusammenhang mit nosokomialen Wundinfektionen. Die eindeutige Diagnose einer Infektion mit MRS bereitet zwar heute keine Probleme mehr, doch sind einige wesentliche Punkte zu beachten, weshalb nur erfahrene Diagnostiker mit dieser Thematik beauftragt werden sollten. Die Therapie erfolgt nach Auswertung des Antibiogramms (unabhängig vom Antibiogramm sind alle β-Lactame als resistent einzustufen) und wenn möglich lokal. Auch die Frage nach dem Zoonosecharakter animaler MRS und den damit verbunden Problembereichen (Hygienemanagement, Haftungsfragen, Sorgfaltspflichten, Einsatz humaner Reservewirkstoffe) tritt zunehmend in den Fokus der öffentlichen Wahrnehmung.

Summary

Over the last decades, various populations of Staphylococcus sp. have acquired a plethora of resistance factors. Currently, infections caused by methicillin-resistant Staphylococcus sp. (MRS) are the most important clinical problem in human health care facilities and are also increasing at a progressive rate in veterinary medicine. Since the early 1970’s MRS infections in animals have been known. However, during the last years we have been experiencing an increasingly high number of reports on MRS, especially regarding wound infections of small animals and horses. Although the microbiological diagnosis of MRS is clearly defined now, some aspects are worth mentioning, thus enforcing diagnosis by experienced personnel only. Clinical infections with MRS can be treated topically (e. g. in superficial, uncomplicated small wounds), but in most cases, systemic antimicrobial therapy is warranted. Therefore, it is mandatory to test the sensitivity of MRS against non-β-lactam in each case. With regard to the zoonotic potential of MRS, it is vital to discuss topics like hygiene management, liability questions, responsibilities and application of last resort agents used in human medicine.

Schlüsselwörter

Resistenz - Antibiogramm - Reserveantibiotika - Zoonose - nosokomiale Infektion

Key words

Resistance - antibiogram - last resort agents - zoonosis - nosocomial infection

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