Antimikrobielle Therapie bei intensivpflichtigen Patienten mit akuter Exazerbation einer COPD
Tóm tắt
Die chronisch-obstruktive Lungenerkrankung (COPD) gehört zu den führenden Todesursachen weltweit. Bei intensivpflichtigen Patienten mit akuter Exazerbation können dabei in etwa 50% der Fälle potenzielle bakterielle Erreger gefunden werden. Am häufigsten sind Haemophilus influenzae und Streptococcus pneumoniae, aber auch Enterobakterien und Pseudomonas aeruginosa. Ebenso können Viren in einem hohen Anteil der Patienten nachgewiesen werden. Die Indikation zur antimikrobiellen Therapie der akut exazerbierten COPD wird weiterhin kontrovers diskutiert, jedoch von aktuellen Leitlinien für alle intensivpflichtigen Patienten empfohlen. Geeignete Substanzen zur empirischen initialen antimikrobiellen Therapie sind Penicilline mit β-Laktamaseinhibitor, Cephalosporine der zweiten und dritten Generation, Carbapeneme und Fluorchinolone. Die antimikrobielle Therapie sollte nach den kulturellen Ergebnissen von Sputum oder tracheobronchialen Sekreten angepasst werden.
Tài liệu tham khảo
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