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01.07.2010 | Medizin aktuell

Prävention und Nachsorge der Sepsis

1. 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. F.M. Brunkhorst, P. Gastmeier, W. Kern, W. Krüger, K. Mayer, A. Weimann, T. Welte, C. Putensen, K. Werdan, K. Reinhart

Erschienen in: Die Innere Medizin | Ausgabe 7/2010

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Zusammenfassung

Die 1. Revision der S2k-Leitlinie der Deutschen Sepsis-Gesellschaft in Kooperation mit 17 weiteren wissenschaftlichen medizinischen Fachgesellschaften und einer Selbsthilfegruppe gibt den Stand des Wissens über effektive und angemessene Krankenversorgung zu Präventions- und Nachsorgemaßnahmen der Sepsis zum Zeitpunkt der „Drucklegung“ wieder. Die Empfehlungen der Leitlinien können nicht unter allen Umständen angemessen genutzt werden. Die Entscheidung darüber, ob einer bestimmten Empfehlung gefolgt werden soll, muss vom Arzt unter Berücksichtigung der beim individuellen Patienten vorliegenden Gegebenheiten und der verfügbaren Ressourcen getroffen werden.

Nur mit Berechtigung zugänglich

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 o. g. 3-armiger Studie online publiziert worden [67]. In respiratorischem Sekret wurden anfänglich ceftazidim-, tobramycin- bzw. ciprofloxacinresistente 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 ciprofloxacinresistenten Bakterien während SDD nachgewiesen, im Vergleich zum Zeitraum vor und nach Anwendung von SDD, während SOD keinen Einfluss hatte. Im Mittel blieb die Prävalenz ceftazidimresistenter 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 Ceftazidimresistenz 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.

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Titel: Prävention und Nachsorge der Sepsis
1. 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. F.M. Brunkhorst
P. Gastmeier
W. Kern
W. Krüger
K. Mayer
A. Weimann
T. Welte
C. Putensen
K. Werdan
K. Reinhart
Publikationsdatum: 01.07.2010
Verlag: Springer-Verlag
Erschienen in: Die Innere Medizin / Ausgabe 7/2010
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI: https://doi.org/10.1007/s00108-010-2663-9

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Prävention und Nachsorge der Sepsis

1. 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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