Skip to main content
SpringerLink
Log in

Komplizierte intraabdominelle Infektionen: Erreger, Resistenzen

Empfehlungen der Infektliga zur Antibiotikatherapie

Complicated intra-abdominal infections: pathogens, resistance

Recommendations of the Infectliga on antbiotic therapy

  • Übersichten
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Intraabdominelle Infektionen entstehen durch das Eindringen von Bakterien in die Wand abdomineller Hohlorgane, und ihre Vermehrung hat Peritonitis oder Abszesse zur Folge. Wenn sich die Infektion in die Bauchhöhle oder andere normalerweise sterile Regionen des Abdominalraums ausbreitet, spricht man von einer komplizierten intraabdominellen Infektion. Die Patienten müssen in Verbindung mit einer rechtzeitigen chirurgischen Herdsanierung antibiotisch behandelt werden.

Nahezu alle intraabdominellen Infektionen sind polymikrobiell und werden durch Bakterien der Darmflora verursacht (Aerobier und fakultative und obligate Anaerobier – Enterobacteriaceae, Enterokokken und Bacteroides fragilis werden am häufigsten isoliert). Die Entstehung einer Antibiotikaresistenz (z. B. ESBL-produzierende Enterobacteriaceae oder multiresistente Enterokokken und Staphylokokken) stellt eine massive Bedrohung für Patienten mit chirurgischen Infektionen dar. Besonders bei Patienten mit nosokomial erworbenen Infektionen kann eine inadäquate empirische Antibiotikabehandlung zu Therapieversagen und zum Tod führen. Bei Risikopatienten sollten Antibiotikaregime mit einem breiten Spektrum, das auch resistente gramnegative Erreger und Anaerobier sowie grampositive Bakterien wie Enterokokken (inkl. VRE) und Staphylokokken beinhaltet, in Betracht gezogen werden.

Abstract

Intra-abdominal infections are generally the result of invasion and multiplication of enteric bacteria in the wall of a hollow viscus within the abdomen to produce peritonitis or abscess. When the infection extends into the peritoneal cavity or another normally sterile region of the abdominal cavity, the infection is described as a „complicated“ intra-abdominal infection. Treatment of patients with complicated intra-abdominal infections involves antimicrobial therapy, generally in conjunction with an appropriate and timely surgical source control.

Nearly all intra-abdominal infections are caused by multiple microorganisms that constitute the intestinal flora (aerobes and facultative and obligate anaerobes, with Enterobacteriaceae, enterococci and Bacteroides fragilis isolated most frequently). The emergence of drug resistance (e.g. ESBL-producing Enterobacteriaceae or resistant enterococci and staphylococci) poses a substantial threat to patients with surgical infections. Especially in patients with nosocomially acquired infections inadequate empiric antibiotic treatment is associated with treatment failure and death. In patients at risk broader spectrum antibiotic regimens with coverage of resistant Gram-negative bacilli and anaerobes and Gram-positive bacteria such as enterococci (including VRE) and staphylococci should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Adam D, Dörr HW, Link H, Lode H (eds) (2004) Die Infektiologie. Springer, Berlin Heidelberg New York, S 33

  2. Angeras MH, Darle N, Hamnström K et al (1996) A comparison of imipenem/cilastatin with the combination of cefuroxime and metronidazole in the treatment of intra-abdominal infections. Scand J Infect Dis 28:513–518

    Article  PubMed  Google Scholar 

  3. Babinchak T, Ellis-Grosse E, Dartois N et al (2005) The efficacy and safety of tigecycline for the treatment of complicated intra-abdominal infections: Analysis of pooled clinical data. Clin Infect Dis 41:354–366

    Article  Google Scholar 

  4. Bare M, Castellis X, Garcia A et al (2002) Excess mortality associated with inappropriate initial empiric antibiotic therapy in patients undergoing surgery for intra-abdominal infection. 12th European Congress of Clinical Microbiology and Infectious Diseases, Milan, Italy, O224

  5. Barie PS, Vogel SB, Dellinger EP et al. (1997) for the Cefepime Intra-abdominal Infection Study Group. A randomized, double-blind clinical trial comparing cefepime plus metronidazole with imipenem-cilastatin in the treatment of complicated intra-abdominal infections. Ann Surg 132:1294–1302

    Google Scholar 

  6. Barie PS, Hydo LJ, Shou J et al (2005) Influence of antibiotic therapy on mortality of critical surgical illness caused or complicated by infection. Surg Infect 6(1):41–54

    Article  Google Scholar 

  7. Burnett RJ, Haverstock DC, Dellinger EP et al (1995) Definition of the role of enterococcus in intra-abdominal infection: analysis of a prospective randomized trial. Surg Infect 118:716–723

    Google Scholar 

  8. Cattan P, Yin DD, Sarfati E et al (2002) Cost of care for patients with community acquired intra-abdominal infections. Eur J Clin Microbiol Infect Dis 21(11):787–793

    Article  PubMed  Google Scholar 

  9. Cohn SM, Lipsett PA, Buchmann PG et al (2000) Comparison of intravenous/oral ciprofloxacin plus metronidazole versus piperacillin/tazobactam in the treatment of complicated intra-abdominal infections. Ann Surg 232:254–262

    Article  PubMed  Google Scholar 

  10. Dupont H (2007) The empiric treatment of nosocomial intra-abdominal infections. Int J Infect Dis 11 [Suppl 1]:1–6

    Google Scholar 

  11. Durst J, Rohen JW (2007) Bauchchirurgie. 2. Aufl. Schattauer, Stuttgart

  12. Ess S, Yin D, Lyu R et al (2002) Outcomes of initial empiric antibiotic therapy and hospital resource use in patients undergoing surgery for community-acquired intra-abdominal infections in three Swiss hospitals. 12th European Congress of Clinical Microbiology and Infectious Diseases, Milan, Italy, O226

  13. Gastmeier P, Sohr D, Geffers C et al (2005) Mortality risk factors with nosocomial Staphylococcus aureus infections in intensive care units: results from the German Nosocomial Infection Surveillance System (KISS). Infection 33(2):50–55

    Article  PubMed  Google Scholar 

  14. Gonzenbach HR (1987) Die Behandlung intraabdomineller Infektionen mit Beta-Laktam-Antibiotika. Resultate einiger kontrollierter, prospektiver Studien. Infection 15:179–182

    Article  Google Scholar 

  15. Hau T (2002) Antibiotic treatment of intra-abdominal infections. Intensive Notfallbehandl 27(1):16–22

    Google Scholar 

  16. Huizinga WK, Warren BL, Baker LW et al (1995) Antibiotic monotherapy with meropenem in the surgical management of intra-abdominal infections. J Antimicrob Chemother 36 [Suppl A]:179–189

  17. Jaccard C, Troillet N, Harbard S et al (1998) Prospective randomized comparison of imipenem-cilastatin and piperacillin-tazobactam in nosocomial pneumonia or peritonitis. Antimicrob Agents Chemother 42:2966–2972

    PubMed  Google Scholar 

  18. Kaye KS, Engemann JJ, Fraimow HS et al (2004) Pathogens resistant to antimicrobial agents: epidemiology, molecular mechanisms, and clinical management. Infect Clin Dis N Am 18:467–511

    Article  Google Scholar 

  19. Kresken M (2008) Highlights der PEG-Resistenzstudie 2007. J Chemother 5:232

    Google Scholar 

  20. Kresken M, Leitner E, Seifert H et al (2008) Empfindlichkeit klinischer Isolate häufig vorkommender Bakterienspezies gegenüber Tigecyclin. J Chemother 5:205–226

    Google Scholar 

  21. Krobot K, Yin D, Zhang Q et al (2004) Effect of inappropriate initial empiric antibiotic therapy on outcome of patients with community acquired intra-abdominal infections. Eur J Clin Microbiol Infect Dis 23:682–687

    Article  PubMed  Google Scholar 

  22. Kujath P, Hoffmann M, Rodloff A (2008) Antibiotika- und Pilztherapie bei intraabdominellen Infektionen. Chirurg 79:295–305

    Article  PubMed  Google Scholar 

  23. Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596

    Article  PubMed  Google Scholar 

  24. Livermore DM (2005) Minimising antibiotic resistance. Lancet Infect Dis 5:450–459

    Article  PubMed  Google Scholar 

  25. Lucasti C, Jasovich A, Umeh O et al (2008) Efficacy and tolerability of iv doripenem versus meropenem in adults with complicated intra-abdominal infection: a phase III, prospective, multicenter, randomized, double-blind noninferiority study. Clin Ther 30(5):868–883

    Article  PubMed  Google Scholar 

  26. Marangoni M, Song J, Herrington J et al (2006) Randomized controlled trial of moxifloxacin compared with piperacillin-tazobactam and amoxicillin-clavulanate for the treatment of complicated intra-abdominal infections. Ann Surg 244(2):204–211

    Article  Google Scholar 

  27. Marshall JC (2004) Intra-abdominal infections. Microbes Infect 6:1015–1025

    Article  PubMed  Google Scholar 

  28. Mazuski JE, Sawyer RG, Nathens AB et al (2002) The Surgical Infection Society guidelines on antimicrobial therapy for intraabdominal infections: an executive summary. Surg Infect 3:161–173

    Article  Google Scholar 

  29. Mazuski JE (2005) Clinical Challenges and Unmet Needs in the Management of Complicated Intra-Abdominal Infections. Surg Infect 6 [Suppl 2]:49–69

    Google Scholar 

  30. Mazuski JE (2007) Antimicrobial treatment for intra-abdominal infections. Expert Opin Pharmacother 8(17):2933–2945

    Article  PubMed  Google Scholar 

  31. Mazuski JE, Solomkin JS (2009) Intra-abdominal infections. Surg Clin North Am 898:421–429

    Article  Google Scholar 

  32. Methar S, Dewar EP, Leaper DJ et al (1997) A multicenter study to compare meropenem and cefotaxime and metronidazole in treatment of hospitalized patients with serious infections. J Antimicrob Chemother 39:631–638

    Article  Google Scholar 

  33. Mosdell DM, Morris DM, Voltura A et al (1991) Antibiotic treatment for surgical peritonitis. Ann Surg 214:543–549

    Article  PubMed  Google Scholar 

  34. Nathans AB, Rotstein OD, Marshall JC (1998) Tertiary Peritonitis: Clinical Features of a Complex Nosocomial Infection. World J Surg 22:158–163

    Article  Google Scholar 

  35. Nyström PO, Bax R, Dellinger EP et al (1990) Proposed definitions for diagnosis, severity scoring, stratification, and outcome for trials on intraabdominal infection. World J Surg 14:148–158

    Article  PubMed  Google Scholar 

  36. Paterson DL (2004) Collateral damage from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 38 [Suppl 4]:341–345

    Google Scholar 

  37. Pieracci FM, Barie PS (2007) Intra-abdominal infections. Curr Opin Crit Care 13:440–449

    Article  PubMed  Google Scholar 

  38. Potoski BA (2006) Evaluation of the guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. Ashp Midyear Clinical Meeting 42:p pi-223

    Google Scholar 

  39. Rapp RP (2000) Overview of resistant gram-positive pathogens in the surgical patient. Surg Infect 1(1):39–47

    Article  Google Scholar 

  40. Raymond DP et al (2002) Preventing antimicrobial-resistant bacterial infections in surgical patients (CDC/SIS position paper). Surg Infect 3(4):375–378

    Article  Google Scholar 

  41. Rodloff A, Leclercq R, Debbia EA et al (2008) Comparative analysis of antimicrobial susceptibility among organisms from France, Germany, Italy, Spain and UK as part of the tigecycline evaluation and surveillance trail. Clin Microbiol Infect 14:307–314

    Article  PubMed  Google Scholar 

  42. Roehrborn A, Thomas L, Potrech O et al (2001) The microbiology of postoperative peritonitis. Clin Infect Dis 33:1513–1519

    Article  PubMed  Google Scholar 

  43. Sandiumenge A, Diaz E, Rodriguez A (2006) Impact of diversity of antimicrobial use on the development of antimicrobial resistance. J Antimicrob Chemother 57:1197–1204

    Article  PubMed  Google Scholar 

  44. Schäfer V, Hunfeld KP (2004) Ambulant erworbene, polymikrobielle Infektionen. Thieme, Stuttgart

  45. Seguin P, Lavoille B, Chanavaz C et al (2006) Factors associated with multidrug-resistant bacteria in secondary peritonitis: impact on antibiotic therapy. Clin Microbiol Infect 12:980–985

    Article  PubMed  Google Scholar 

  46. Seifert H, Leitner E, Körber-Irrgang B et al (2008) Comparative in vitro activity of tigecycline against clinical isolates of the Acinetobacter baumannii group: results of the German TEST (G-TEST) surveillance program 2005-2007. 48th ICAAC, Washington D.C., Abstract/Poster C2-3870

  47. Sendt W, Altendorf-Hofmann A, Scheele J et al (2002) Association between inappropriate initial empiric antibiotic therapy and the need for re-operation and second-line therapy among German patients undergoing surgery for community acquired intra-abdominal infections.12th European Congress of Clinical Microbiology and Infectious Diseases, Milan, Italy, O225

  48. Sitges-Serra A, López MJ, Girvent M et al (2002) Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis. Br J Surg 89:361–367

    Article  PubMed  Google Scholar 

  49. Solomkin JS, Mazuski JE, Baron EJ et al (2003) Guidelines for the selection of anti-infective agents for complicated intraabdominal infections. Clin Infect Dis 37:997–1005

    Article  PubMed  Google Scholar 

  50. Solomkin JS, Yellin AE, Rotstein OD et al (2003) Ertapenem versus Piperacillin/Tazobactam in the treatment of complicated intraabdominal infections. Results of a double-blind, randomized, comparative trail. Ann Surg 237(2):235–245

    Article  PubMed  Google Scholar 

  51. Swenson RM, Lorber B, Michaelson TC (1974) The bacteriology of intra-abdominal infections. Arch Surg 109:398–399

    PubMed  Google Scholar 

  52. Töns C (2006) Gastroenterologische Chirurgie, 2. Aufl. Springer, Heidelberg

  53. Vogel F, Bodmann KF u (2004) Expertenkommission der Paul-Ehrlich-Gesellschaft. Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen. J Chemother 13(2):46–105

    Google Scholar 

  54. Wacha H, Hau T, Dittmer R, Ohmann C, the Peritonitis Study Group (1999) Risk factors associated with intra-abdominal infections: a prospective multicenter study. Langenbecks Arch Surg 384:24–32

    Article  PubMed  Google Scholar 

  55. Wacha H, Warren B, Bassaris H, Nikolaidis P, the Intra-Abdominal Infections Study Group (2006) Comparison of Sequential Intravenous/Oral Ciprofloxacin Plus Metronidazole with Intravenous Ceftriaxone Plus Metronidazole for Treatment of Complicated Intra-Abdominal Infections. Surg Infect 7(4):341

    Article  Google Scholar 

  56. Walker AP, Nichols RL, Wilson RF et al (1993) Efficacy of a beta-lactamase inhibitor combination for serious intraabdominal infections. Ann Surg 217:115–121

    Article  PubMed  Google Scholar 

  57. Weber SG et al (2003) Fluoroquinolones and the risk for methicillin-resistant staphylococcus aureus in hospitalized patients. Emerg Infect Dis 9:1415–1422

    PubMed  Google Scholar 

  58. Weber DJ (2006) Collateral damage and what the future might hold. The need to balance prudent antibiotic utilization and stewardship with effective patient management. Int J Infect Dis 10 [Suppl 2]:17–24

  59. Werner G (2008) VRE – ein Problem für Deutschland? J Chemother 5:233

    Google Scholar 

  60. Wilcox MH (2006) Tigecycline and the need for a new broad-spectrum antibiotic class. Surg Infect 7(1):69–80

    Article  Google Scholar 

  61. http://www.sepsis-gesellschaft.de Prävalenzstudie des SepNet

  62. http://www.p-e-g.org

  63. earss: European Antimicrobial Resistance Surveillance Study; http://www.rivm.nl/earss/database/

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Vorträge und/oder beratende Tätigkeit für folgende Firmen: Bayer, Brahms, Janssen-Cilag, MSD, Novartis, Pfizer, Wyeth.

Author information

Authors and Affiliations

  1. Klinikum Barnim, Werner Forßmann Krankenhaus Eberswalde, Rudolf-Breitscheid-Straße 100, 16225, Eberswalde, Deutschland

    K.-F. Bodmann

Authors
  1. K.-F. Bodmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

und die Expertenkommission der Infektliga

Corresponding author

Correspondence to K.-F. Bodmann.

Additional information

Expertenkommission der Infektliga: Dieter Adam, Wolfgang Elies, Rainer Höhl, Peter Kujath, Cordula Lebert, Kurt Naber, Annette Pross, Arne Rodloff, Kuno Rommelsheim, Fritz Sörgel, Friedrich Vogel, Hannes Wacha

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bodmann, KF., und die Expertenkommission der Infektliga. Komplizierte intraabdominelle Infektionen: Erreger, Resistenzen. Chirurg 81, 38–49 (2010). https://doi.org/10.1007/s00104-009-1822-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-009-1822-9

Schlüsselwörter

Keywords

Search

Navigation