Post on 28-Mar-2020
transcript
PubMed 12.02.2017
Stichwort ESBL – E. coli
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Mädchen, 6 Jahre alt
Herkunft „Goldener Halbmond“
perforierte Appendizitis
Enterobakterien in vitro DSP Blutkulturen 2015
Gramnegative Sepsis
Bauch, Harntrakt
Bis vor 5 Jahren
• Amoxicillin / Clav
• Ampicillin / Sulb
• Ciprofloxacin
• Levofloxacin
Jetzt
• Tazonam
• Cephalosporine 3 & 4
• Peneme
All-cause mortality at the end of follow-up for BL/BLIs versus carbapenems
b-Lactam/b-lactamase inhibitors versus carbapenems for the treatment of sepsis:
systematic review and meta-analysis of randomized controlled trials Shachaf Shibe, JAC 2015
Carbapeneme
Substanz Indikation Bemerkung
Ertapenem
Invanz
ESBL
SSTI
IAI
1 x täglich
ambulante i.v. AB Therapie !
Septischer Bauch !
Urosepsis! Imipenem
Meropenem 3 x 1 gr
nosokomial
Meropenem in Vitro DSP 2013-2015 (ca. 2090 Einzelisolate)
Fosfomycin facts
• Gute Penetration in schwer
erreichbare Kompartments
Knochen, Liquor, Lunge, …
• Gute Penetration in
Abszesse
• aktiv bei niedrigem pH
• Synergie mit Laktamen
• keine Organtoxizität
• Elektrolyte !
• therapeutische Breite
12 – 16 – 24 gr / Tag
• Inhalativ, Dauerinfusion
Fosfomycin Indikationen
alt
• DFS
• Pleuraempyem
• Hirnabszess, …
• Osteitis
• komplizierte …
neu z.B.
• Harnwegsinfekte
• urologische Prophylaxe
• chirurgische Prophylaxe
• Empirie bei V.a. MRE
• Monotherapie!
Matthew E. Falagas et al. Clin Infect Dis. 2008;46:1069-1077
Amikacin fosfomycin inhalation solution 300 mg of amikacin 120 mg
of fosfomycin twice daily for 10 days
Nebulized and intravenous colistin in experimental pneumonia
caused by Pseudomonas aeruginosa
Quin Lu
Efficacy of High-dose Nebulized Colistin (3 x 5 MIO !!!) in Ventilator associated
Pneumonia Caused by Multidrug-resistant Pseudomonas aeruginosa and
Acinetobacter baumannii Qin Lu, Anesthesiology 2012
During the subsequent cultures, the last cultures positive for MDRAB in the case
group were at day 8.2 ± 6.4 after the index day, but were at day 21.5 ± 4.5 (p
<0.001) in the control group
Inhal. Dosierung 2 x 2 MIO IE
Tigecyclin & Acinetobacter
• Occurrence of carbapenem-resistant Acinetobacter baumannii clones at multiple hospitals in London and Southeast England. J Clin Microbiol. 2006
• Activity of tigecycline (GAR-936) against Acinetobacter baumannii strains, including those resistant to imipenem. Antimicrob Agents Chemother. 2004
• Successful treatment of septic shock due to pan-resistant Acinetobacter baumannii using combined antimicrobial therapy including tigecycline. Eur J Clin Microbiol Infect Dis. 2006
Pharmacokinetic Considerations regarding Tigecycline for Multidrug-
Resistant (MDR) Klebsiella pneumoniae or MDR Acinetobacter
baumannii Urosepsis
Burke A. Cunha in JOURNAL OF CLINICAL MICROBIOLOGY, 2009
High-dose tigecycline-associated alterations in coagulation
parameters in critically ill patients with severe infections International Journal of Antimicrobial Agents 45 (2015) 84–95
Neue AB ab 2015
• Ceftarolin ZINFORO ®
• Ceftobiprol ZEVTERA ®
• Ceftazidim – Avibactam CEREXA ®
AVYZAC ®
• Ceftolozan – Tazobactam ZERBAXA ®
• Tedizolid SIVEXTRO ®
• Dalbavancin XYDALBA ®
• Oritovancin ORBACTIV ®
Ceftolozan Tazobactam in vitro Februar & März 2016
Pat liegt im DSP von Mrz - Juli
April Mai Juni
Colistin pharmacokinetics
Clinical Microbiology and Infection Volume 18, Issue 1, pages 30-39, 11 OCT 2011
Simulations of steady-state colistin methanesulphonate (CMS) (a) and colistin (b) plasma concentrations vs. time following administration of the same daily dose of CMS with various dosing regimens (9 MIU/24 h (red), 4.5 MIU/12 h (blue), and 3 MIU/8 h (green)), for a typical patient with creatinine clearance set at 60 mL/min, CMS non-renal clearance and colistin clearance equal to 50 mL/min, and CMS and colistin Vss set at 15 L.
Efficacy and safety of high-dose ampicillin/sulbactam vs. colistin as monotherapy for the
treatment of multidrug resistant Acinetobacter baumannii ventilator-associated
pneumonia
Alex P. Betrosian et al Journal of Infection (2008)
COL 3 MIU every 8 h
Amp/Sulb 9 g every 8 h
• In the kill-curve studies
azithromycin and rifampin were rapidly bactericidal
sulbactam was more slowly bactericidal.
Trovafloxacin and doxycycline were bacteriostatic
None of the antimicrobials tested were bactericidal against
all strains tested
• The synergy studies demonstrated that the combinations of
sulbactam with azithromycin, rifampin, doxycycline, or
trovafloxacin were generally additive or indifferent.