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Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51(02): 122-125
DOI: 10.1055/s-0041-103159
Fachwissen
Intensivmedizin: Topthema
© Georg Thieme Verlag Stuttgart · New York

Multiresistente Erreger – Antibiotic Stewardship

Antibiotic Stewardship
Christian Lanckohr
,
Björn Ellger
Further Information

Publication History

Publication Date:
07 March 2016 (online)

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Die adäquate Behandlung von Infektionen ist eine wichtige Aufgabe in der Intensivmedizin, die für das Überleben der Patienten oft ausschlaggebend ist. Typischerweise finden sich auf Intensivstationen daher in der Regel hohe Anwendungsdichten von Antibiotika. In Anbetracht einer besorgniserregenden Resistenzentwicklung ist es dringend geboten, den Einsatz von Antiinfektiva zu optimieren, um den Resistenzdruck zu verringern. AntibioticStewardship versucht, das Infektionsmanagement durch interdisziplinäre Zusammenarbeit auf mehreren Ebenen zu verbessern. Übergeordnetes Ziel von ABS ist eine Verlangsamung der Resistenzentwicklung zur Schonung der wertvollen Ressource „Antibiotikum“. Insbesondere die Intensivstation ist ein wichtiges Betätigungsfeld für AntibioticStewardship. Der vorliegende Artikel diskutiert praktische Aspekte sowie die verfügbare Evidenz für AntibioticStewardship.

The adequate management of infections is an important task in critical care medicine which has an effect on patient outcome. As a result, the prevalence of antiinfective therapy is high in intensive care units. In the face of an unsettling development of worldwide microbial resistance, an optimization and reduction of antiinfective therapy is necessary. Antibiotic stewardship tries to improve antiinfective therapy with an interdisciplinary approach. One overall objective of antibiotic stewardship is the reduction of resistance induction in order to preserve the therapeutic efficiency of antibiotics. Intensive care units are important fields of action for antibiotic stewardship interventions. This article reviews available evidence and some practical aspects for antibiotic stewardship.

Kernaussagen

  • Die weltweite Resistenzentwicklung erfordert eine Einschränkung des Antibiotikaeinsatzes, um den Resistenzdruck zu verringern.

  • Antibiotic Stewardship bietet ein evidenzbasiertes Maßnahmenbündel zur Optimierung des Antibiotikaeinsatzes, das auch bei kritisch kranken Patienten auf der Intensivstation angewendet werden kann.

  • Nachteilige Auswirkungen eines zurückhaltenderen Antibiotikaeinsatzes auf das Patienten-Outcome konnten bisher nicht nachgewiesen werden.

  • Interventionen im Sinne von ABS stützen sich auf eine krankenhausweite Infrastruktur, welche die Grundlagen für ein interdisziplinär unterstütztes Infektionsmanagement schaffen.

  • Zu den Strategien von Antibiotic Stewardship gehören die resistogrammgerechte Deeskalation, die Verkürzung der Therapiedauer sowie der qualifizierte Einsatz der mikrobiologischen Diagnostik.

  • Die Therapie lebensbedrohlicher Infektionen ist eine intensivmedizinische Kernkompetenz. Die Kenntnisse des Intensivmediziners in der Infektionsbehandlung eignen sich in besonderer Weise zur Einbettung in Antibiotic-Stewardship-Programme.

Schlüsselwörter:

Antibiotic Stewardship - Intensivmedizin - Resistenzentwicklung

Keywords:

antibiotic stewardship - intensive care medicine - antibiotic resistance

Ergänzendes Material

 

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