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Infektionen und Sepsis durch intravenöse Katheter

Infections and sepsis due to intravascular catheters

  • Schwerpunkt: Klinische Infektiologie
  • Published:
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Zusammenfassung

Infektionen und mechanische Komplikationen sind beim Einsatz von intravenösen Kathetern häufig und können zu lebensbedrohlichen Situationen führen. Sie sind die häufigste Ursache der gefährlichsten nosokomialen Infektion auf Intensivstationen, der Sepsis. Die Prävention basiert auf einem mehrstufigen Konzept, das dem Risikoprofil der Patienten und der Häufigkeit dieser Infektion in einem Krankenhaus Rechnung trägt. Die Richtlinien des Robert-Koch-Instituts sind eine ausgezeichnete Grundlage, ein Präventionsprogramm risikogerecht für eine Klinik zu definieren. Bei Verdacht auf Kathetersepsis kann der Katheter entweder sofort ersetzt oder gezogen und die Katheterspitze ins Labor geschickt werden, bei weniger kritisch Erkrankten können gleichzeitig Blutkulturen aus dem Katheter und aus einer peripheren Vene abgenommen werden. Mittels Ausbildung zur aseptischen Einlage, der korrekten Pflege und Einsatz des richtigen Katheters nach Infusionsbedarf können die Infektionsraten auf weniger als 1 Kathetersepsis pro 1000 Kathetertage gesenkt werden. Nur in Spezialfällen sind mit Antiobiotika oder Antiseptika beschichtete Katheter sinnvoll, dies vor allem bei Transplantierten und Verbrennungspatienten.

Abstract

Intravascular catheters are an indispensable part of modern medicine, but also a frequent source for bloodstream infections. The incidence of infection depends on the catheter type, type of hospital setting (intensive care unit vs ward), and underlying diseases of the patient, and the type and resources for the prevention program. Initially, a common portal of bacterial entry is the insertion site. After prolonged catheterization, the hub (the connection between the catheter and the infusing tube) becomes the predominant source of bacterial entry. Basic surveillance data guide a risk-adjusted prevention program for an individual health care institution. The guidelines issued by the Robert-Koch-Institute are still an excellent framework: In cases of suspected catheter-related bloodstream infection, the catheter can be immediately removed and submitted to the laboratory, or — in less severe cases — blood cultures can be simultaneously drawn by venous cut-down and cultures through the catheter. Health care education, training and monitoring or insertion, maintenance are paramount to prevent catheter-related bloodstream infection. Coated catheters are indicated for special patient populations such as burn patients or transplant patients.

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  1. Klinik für Infektiologie, Universitätsspital Basel, Schweiz

    A. F. Widmer MS

  2. Klinik für Infektiologie, Universitätsspital, Petersgraben 4, 4031, Basel, Schweiz

    A. F. Widmer MS

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Widmer, A.F. Infektionen und Sepsis durch intravenöse Katheter. Internist 46, 643–651 (2005). https://doi.org/10.1007/s00108-005-1399-4

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