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01.04.2010 | Leitlinien und Empfehlungen

Prävention, Diagnose, Therapie und Nachsorge der Sepsis

Erste Revision der S2k-Leitlinien der Deutschen Sepsis-Gesellschaft e.V. (DSG) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI)

verfasst von: Prof. Dr. K. Reinhart, Prof. Dr. F.M. Brunkhorst, H.-G. Bone, J. Bardutzky, C.-E. Dempfle, H. Forst, P. Gastmeier, H. Gerlach, M. Gründling, S. John, W. Kern, G. Kreymann, W. Krüger, P. Kujath, G. Marggraf, J. Martin, K. Mayer, A. Meier-Hellmann, M. Oppert, C. Putensen, M. Quintel, M. Ragaller, R. Rossaint, H. Seifert, C. Spies, F. Stüber, N. Weiler, A. Weimann, K. Werdan, T. Welte

Erschienen in: Die Anaesthesiologie | Ausgabe 4/2010

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Unter Mitwirkung von medizinisch-wissenschaftliche Fachgesellschaften: …

Aufgrund der – nach Abschluss des Konsentierungsverfahrens der vorliegenden Leitlinie – publizierten Ergebnisse im Kontrollarm der NICE-SUGAR-Studie hat die Surviving Sepsis Campaign vor Kurzem einen Schwellenwert von >180 mg/dl (10,0 mmol/l) vorgeschlagen.

Nach Konsentierung sind weitere Daten zur Resistenz unter oben genannter 3-armiger Studie online publiziert worden [410]. In respiratorischem Sekret wurden anfänglich Ceftazidim-, Tobramycin- bzw. Ciprofloxacin-resistente Bakterien bei 10, 10 bzw. 14% der Patienten gefunden. Unter SDD oder SOD fiel der Nachweis signifikant auf 4, 6 bzw. 5% und stieg danach wieder signifikant auf das Ausgangsniveau an (10, 12 bzw. 12%). In Rektalabstrichen wurde gleichermaßen eine signifikante Suppression von Tobramycin- und Ciprofloxacin-resistenten Bakterien während SDD nachgewiesen im Vergleich zum Zeitraum vor und nach Anwendung von SDD, während SOD keinen Einfluss hatte. Im Mittel blieb die Prävalenz Ceftazidim-resistenter Bakterien vor und während Anwendung von SDD gleich (Nachweis bei 6 bzw. 5% der Patienten), stieg aber nach Anwendung von SDD signifikant auf 15% an. Die Daten bestätigen frühere Publikationen, in denen während Anwendung von SDD sogar weniger resistente Bakterien nachgewiesen wurden, der postinterventionelle Anstieg der Ceftazidim-Resistenz in Rektalabstrichen unterstreicht aber nochmals die Notwendigkeit zum Führen von Resistenzstatistiken.

Siehe auch „Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand: Juli 2009“. Quelle: Epidemiologisches Bulletin 2009; 30:279–299.

Der Auflage der Zulassungsbehörde EMEA folgend, führt der Hersteller gegenwärtig eine multizentrische, doppelblinde, placebokontrollierte Studie an 1500 Patienten mit septischem Schock durch. Der Prüfplan zu dieser Studie wurde im Vorfeld veröffentlicht (Intensive Care Med 2008, 34:1935–1947).

Bezüglich der Angabe von Organkomplikationen gelten die Definitionen der Deutschen Sepsis-Gesellschaft (s. Tabelle 3).

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Titel: Prävention, Diagnose, Therapie und Nachsorge der Sepsis
Erste Revision der S2k-Leitlinien der Deutschen Sepsis-Gesellschaft e.V. (DSG) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI)
verfasst von: Prof. Dr. K. Reinhart
Prof. Dr. F.M. Brunkhorst
H.-G. Bone
J. Bardutzky
C.-E. Dempfle
H. Forst
P. Gastmeier
H. Gerlach
M. Gründling
S. John
W. Kern
G. Kreymann
W. Krüger
P. Kujath
G. Marggraf
J. Martin
K. Mayer
A. Meier-Hellmann
M. Oppert
C. Putensen
M. Quintel
M. Ragaller
R. Rossaint
H. Seifert
C. Spies
F. Stüber
N. Weiler
A. Weimann
K. Werdan
T. Welte
Publikationsdatum: 01.04.2010
Verlag: Springer-Verlag
Erschienen in: Die Anaesthesiologie / Ausgabe 4/2010
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-010-1719-5

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Prävention, Diagnose, Therapie und Nachsorge der Sepsis

Erste Revision der S2k-Leitlinien der Deutschen Sepsis-Gesellschaft e.V. (DSG) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI)

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